Provider Demographics
NPI:1821712365
Name:FOOTE-MILLER, LISA DAWN
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:FOOTE-MILLER
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 1:1051 E CANFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4678
Mailing Address - Country:US
Mailing Address - Phone:313-405-0773
Mailing Address - Fax:
Practice Address - Street 1:1051 E CANFIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4678
Practice Address - Country:US
Practice Address - Phone:313-405-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty