Provider Demographics
NPI:1124757372
Name:AMOYAN, MARY JOAN (CNA)
Entity type:Individual
Prefix:
First Name:MARY JOAN
Middle Name:
Last Name:AMOYAN
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 1:4570 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4106
Mailing Address - Country:US
Mailing Address - Phone:248-952-4232
Mailing Address - Fax:
Practice Address - Street 1:4570 MARTIN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4106
Practice Address - Country:US
Practice Address - Phone:248-952-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI000060386376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM1000060386OtherNURSE AID REGISTRY