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Individual
DAJUAN FANNING
Active
Individual
DAJUAN FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703116420
MI
372500000X
Chore Provider
—
NULL
374U00000X
Home Health Aide
—
NULL
405300000X
Prevention Professional
4703116420
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4703116420
BCBS
MI
05
—
4703116420
—
MI
Enumeration date
06/11/2019
Last updated
06/11/2019
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