Provider Demographics
NPI:1013732999
Name:CASEY, PRECIOUS LATORIA
Entity type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:LATORIA
Last Name:CASEY
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 1:533 NORTH AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1608
Mailing Address - Country:US
Mailing Address - Phone:616-370-5965
Mailing Address - Fax:
Practice Address - Street 1:3769 QUARTON RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48302-4058
Practice Address - Country:US
Practice Address - Phone:248-894-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other