Provider Demographics
NPI:1548091093
Name:FORD, FAYEONNA C
Entity type:Individual
Prefix:
First Name:FAYEONNA
Middle Name:C
Last Name:FORD
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 1:40703 LONG HORN DR # A
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4224
Mailing Address - Country:US
Mailing Address - Phone:313-970-3887
Mailing Address - Fax:
Practice Address - Street 1:40703 LONG HORN DR # A
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-4224
Practice Address - Country:US
Practice Address - Phone:313-970-3887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide