Provider Demographics
NPI:1679355283
Name:ALSANA, ANTOINETE ANTWAN
Entity Type:Individual
Prefix:
First Name:ANTOINETE
Middle Name:ANTWAN
Last Name:ALSANA
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 1:17554 NICK DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1670
Mailing Address - Country:US
Mailing Address - Phone:586-804-1906
Mailing Address - Fax:
Practice Address - Street 1:17554 NICK DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-1670
Practice Address - Country:US
Practice Address - Phone:586-804-1906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide