Provider Demographics
NPI:1619625837
Name:DAVIS, LEANNA KENETRIA
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:KENETRIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20065 HUNT CLUB DR
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1757
Mailing Address - Country:US
Mailing Address - Phone:313-569-7057
Mailing Address - Fax:
Practice Address - Street 1:20065 HUNT CLUB DR
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1757
Practice Address - Country:US
Practice Address - Phone:313-569-7057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide