Provider Demographics
NPI:1073346482
Name:REID, KESHONA C (CNA)
Entity type:Individual
Prefix:
First Name:KESHONA
Middle Name:C
Last Name:REID
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34490 CLINTON PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3349
Mailing Address - Country:US
Mailing Address - Phone:313-737-5074
Mailing Address - Fax:
Practice Address - Street 1:34490 CLINTON PLAZA DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-3349
Practice Address - Country:US
Practice Address - Phone:313-737-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI000036494376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide