Provider Demographics
NPI:1407204464
Name:NANCY KISSICK'S PROFESSIONAL NURSING SERVICES, INC.
Entity type:Organization
Organization Name:NANCY KISSICK'S PROFESSIONAL NURSING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LELSIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:586-286-1141
Mailing Address - Street 1:37040 GARFIELD RD
Mailing Address - Street 2:SUITE T-6
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3646
Mailing Address - Country:US
Mailing Address - Phone:248-804-3566
Mailing Address - Fax:
Practice Address - Street 1:37040 GARFIELD RD
Practice Address - Street 2:SUITE T-6
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3646
Practice Address - Country:US
Practice Address - Phone:248-804-3566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health