Provider Demographics
NPI:1619767225
Name:KING, DEMIRA MONTASIA
Entity type:Individual
Prefix:
First Name:DEMIRA
Middle Name:MONTASIA
Last Name:KING
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 1:1167 AMOS ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-1803
Mailing Address - Country:US
Mailing Address - Phone:248-499-3385
Mailing Address - Fax:
Practice Address - Street 1:1167 AMOS ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-1803
Practice Address - Country:US
Practice Address - Phone:248-499-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula