Individual
DATISIA M MCCOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4674 STAUFFER AVE SE, KENTWOOD, MI 49508-5018
(616) 856-0556
Mailing address
PO BOX 8331, KENTWOOD, MI 49518-8331
(616) 856-0556
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
230009775470405
MI
Other
Enumeration date
02/02/2021
Last updated
02/02/2021
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