Provider Demographics
NPI:1578966107
Name:KISER, CARLA (CNA- HHA)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:
Last Name:KISER
Suffix:
Gender:F
Credentials:CNA- HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14954 HARTWELL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-3693
Mailing Address - Country:US
Mailing Address - Phone:313-736-0208
Mailing Address - Fax:
Practice Address - Street 1:14954 HARTWELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3693
Practice Address - Country:US
Practice Address - Phone:313-736-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI376K0000X376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide