Provider Demographics
NPI:1427804657
Name:ELVINE, CEJUANA
Entity type:Individual
Prefix:
First Name:CEJUANA
Middle Name:
Last Name:ELVINE
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 1:42756 WINDING POND TRL
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-7203
Mailing Address - Country:US
Mailing Address - Phone:248-979-4449
Mailing Address - Fax:
Practice Address - Street 1:30711 BEECHWOOD ST APT 46310
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-2801
Practice Address - Country:US
Practice Address - Phone:248-979-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide