Provider Demographics
NPI:1982207882
Name:DANCY, ALTHEA RENEE (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:ALTHEA
Middle Name:RENEE
Last Name:DANCY
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:MS
Other - First Name:ALTHEA
Other - Middle Name:R
Other - Last Name:STOVALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:12615 METTETAL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1241
Mailing Address - Country:US
Mailing Address - Phone:734-834-2935
Mailing Address - Fax:
Practice Address - Street 1:12615 METTETAL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1241
Practice Address - Country:US
Practice Address - Phone:734-834-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9428286Medicaid