Provider Demographics
NPI:1316273030
Name:MORRISON-KOUROUMA, CHANTELLE (RN)
Entity type:Individual
Prefix:MRS
First Name:CHANTELLE
Middle Name:
Last Name:MORRISON-KOUROUMA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13560 E MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-3426
Mailing Address - Country:US
Mailing Address - Phone:313-469-9260
Mailing Address - Fax:313-469-9260
Practice Address - Street 1:11807 WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1618
Practice Address - Country:US
Practice Address - Phone:313-469-9260
Practice Address - Fax:313-469-9260
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704258152163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI77Medicaid