Provider Demographics
NPI:1952848475
Name:BOND, CHARMAINE (RN, LMT)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:
Last Name:BOND
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30555 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1221
Mailing Address - Country:US
Mailing Address - Phone:248-567-2755
Mailing Address - Fax:
Practice Address - Street 1:30555 SOUTHFIELD RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1221
Practice Address - Country:US
Practice Address - Phone:248-567-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235547163W00000X
MI7501000867225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse