Provider Demographics
NPI:1649096751
Name:YOUNG, ANTIANNA MAHREI
Entity type:Individual
Prefix:
First Name:ANTIANNA
Middle Name:MAHREI
Last Name:YOUNG
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 1:2515 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-3607
Mailing Address - Country:US
Mailing Address - Phone:313-707-8528
Mailing Address - Fax:
Practice Address - Street 1:2515 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-3607
Practice Address - Country:US
Practice Address - Phone:313-707-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide