Provider Demographics
NPI:1710737879
Name:LEAVERSON, KASHAE
Entity Type:Individual
Prefix:MISS
First Name:KASHAE
Middle Name:
Last Name:LEAVERSON
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 1:32406 CONCORD DR APT A
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1217
Mailing Address - Country:US
Mailing Address - Phone:734-560-9457
Mailing Address - Fax:
Practice Address - Street 1:16836 WARD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-4235
Practice Address - Country:US
Practice Address - Phone:313-808-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide