Provider Demographics
NPI:1093542342
Name:KANYO, JOLENE MARIE
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:MARIE
Last Name:KANYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 N LITTLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-8491
Mailing Address - Country:US
Mailing Address - Phone:320-219-0776
Mailing Address - Fax:
Practice Address - Street 1:1107 S SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6852
Practice Address - Country:US
Practice Address - Phone:989-839-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703106555164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse