Provider Demographics
NPI:1679037600
Name:KANYUH, AVERI M
Entity Type:Individual
Prefix:
First Name:AVERI
Middle Name:M
Last Name:KANYUH
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 1:10378 V.05 RD
Mailing Address - Street 2:
Mailing Address - City:RAPID RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49878-9493
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10378 V.05 RD
Practice Address - Street 2:
Practice Address - City:RAPID RIVER
Practice Address - State:MI
Practice Address - Zip Code:49878-9493
Practice Address - Country:US
Practice Address - Phone:906-399-2741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer