Provider Demographics
NPI:1982431219
Name:LOURA, TSEDAQAH
Entity type:Individual
Prefix:
First Name:TSEDAQAH
Middle Name:
Last Name:LOURA
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 1:300 CARE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2206
Mailing Address - Country:US
Mailing Address - Phone:313-922-2222
Mailing Address - Fax:866-287-5710
Practice Address - Street 1:300 CARE CENTER DR
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2206
Practice Address - Country:US
Practice Address - Phone:313-922-2222
Practice Address - Fax:866-287-5710
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist