Individual
DETAVIA KENAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMA
Contact information
Practice address
2 CENTERVIEW DR STE 64, GREENSBORO, NC 27407-3708
(336) 303-0587
Mailing address
555 WHISTLING SWAN DR, GREENSBORO, NC 27455-1535
(919) 696-6125
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
07/26/2024
Last updated
07/26/2024
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