Provider Demographics
NPI:1063236933
Name:REDDING, CAIRA (LPN)
Entity type:Individual
Prefix:
First Name:CAIRA
Middle Name:
Last Name:REDDING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15516 BEAVERLAND ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1473
Mailing Address - Country:US
Mailing Address - Phone:810-316-9299
Mailing Address - Fax:
Practice Address - Street 1:15516 BEAVERLAND ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-1473
Practice Address - Country:US
Practice Address - Phone:810-316-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703123732164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty