Provider Demographics
NPI:1093543381
Name:HUNTER, LAKISHA NICOLE (LPN,)
Entity type:Individual
Prefix:
First Name:LAKISHA
Middle Name:NICOLE
Last Name:HUNTER
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 1:5614 DRAKE HOLLOW DR W
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1274
Mailing Address - Country:US
Mailing Address - Phone:248-961-0095
Mailing Address - Fax:
Practice Address - Street 1:19704 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2762
Practice Address - Country:US
Practice Address - Phone:248-600-9277
Practice Address - Fax:248-600-9277
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703105114164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse