Provider Demographics
NPI:1124879010
Name:HAM, DETOYA D
Entity type:Individual
Prefix:
First Name:DETOYA
Middle Name:D
Last Name:HAM
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 1:3193 BOARDWALK DR UNIT 5211
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-5804
Mailing Address - Country:US
Mailing Address - Phone:470-316-9062
Mailing Address - Fax:
Practice Address - Street 1:3193 BOARDWALK DR UNIT 5211
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-5804
Practice Address - Country:US
Practice Address - Phone:470-316-9062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide