LATONYA WALLACE-HARDIMAN (NPI# 1053818039) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053818039 |
| Entity Type | Individual |
| Full Name | LATONYA WALLACE-HARDIMAN |
| Credential | BA, MSA |
| Practice Address |
5830 Conner St Detroit MI 48213-3458 |
| Mailing Address |
162 Sand Bar Ln Detroit MI 48214-8034 |
| Practice Telephone | 3139241456 |
| Practice Fax Number | 3136362290 |
| Mailing Telephone | 3137157170 |
| Mailing Fax Number | 3136362290 |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2018-04-06 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP3300X |
Clinic/Center Specialization: Pain |
Ambulatory Health Care Facilities |
| Street Address |
5830 CONNER ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48213-3458 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255442190 | Life- Alysis Kidney Center, LLC | Health Maintenance Organization | 5830 Conner St, Detroit, MI 48213-3458 | 2006-08-31 |
| 1568079697 | One Step At A Time Physical Therapy, L.L.C. | Clinic/Center | 5830 Conner St, Detroit, MI 48213-3458 | 2020-09-23 |
| 1689151946 | Woodward Boulevard Medical Bldg., LLC. | Clinic/Center | 5830 Conner St, Detroit, MI 48213-3458 | 2018-07-19 |
| 1437374030 | Suezette Olaker | Family Medicine | 5830 Conner St, Detroit, MI 48213 | 2007-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215540430 | Sheronda Lanetta Blackmon | Licensed Practical Nurse | 13929 Harper Ave., Detroit, MI 48213 | 2020-08-27 |
| 1073049144 | Cheryl Williams | Community Health Worker | 13929 Chalmers Ave., Detroit, MI 48213 | 2017-05-10 |
| 1164963401 | Smile Fresh Detroit PC | Dentist | 7230 Gratiot Avenue, Detroit, MI 48213 | 2017-03-20 |
| 1255887899 | Jay Washington | Behavioral Analyst | 9146 Haper, Detroit, MI 48213 | 2016-09-01 |
| 1396129532 | Sarietha King | Home Health | 14639 Manistique, Detroit, MI 48213 | 2015-07-17 |
| 1366823197 | Royal Treatment Mental Health Systems, LLC | Counselor | 5555 Corner Avenue, Detroit, MI 48213 | 2015-06-17 |
| 1477956779 | Monique Powell | Student in an Organized Health Care Education/Training Program | 5801 Lakeview S.t, Detroit, MI 48213 | 2014-09-30 |
| 1629339163 | Samuel Joseph Farmer | Counselor | 10100 Harper Ave., Detroit, MI 48213 | 2012-05-31 |
| 1609164755 | Vernon Keith Johnson | Social Worker | 20203 Kelly Road, Detroit, MI 48213 | 2011-07-11 |
| 1023312790 | Davenport Quality Home Care LLC | Home Health | 5027 Maxwell, Detroit, MI 48213 | 2011-01-10 |
| Find all providers in zip 48213 | ||||
| Taxonomy Code | 261QP3300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Pain |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588274401 | Vip Medical Care | Clinic/Center | 18940 Schoolcraft, Detroit, MI 48223-2906 | 2020-08-05 |
| 1194180901 | Michigan Pain&spine Clinic Pllc | Clinic/Center | 4201 Saint Antoine St, Suite 6b, University Health Center, Detroit, MI 48201-2153 | 2015-12-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649813650 | Metro Med Pain Management & Rehab Plc | Clinic/Center | 4520 Firestone St Ste A, Dearborn, MI 48126-4602 | 2019-10-22 |
| 1295382976 | Care Recovery Clinic Pllc | Clinic/Center | 13530 Michigan Ave Ste 301, Dearborn, MI 48126-3555 | 2019-08-19 |
| 1902459860 | Comprehensive Care Pain Management, P.C. | Clinic/Center | 9001 15 Mile Rd Ste C, Sterling Heights, MI 48312-3621 | 2019-07-19 |
| 1386296077 | Michigan Institute of Musculoskeletal Medicine Pllc | Clinic/Center | 26206 W 12 Mile Rd Ste 200, Southfield, MI 48034-8500 | 2019-07-12 |
| 1740832930 | Heights Pain Management & Rehab Plc | Clinic/Center | 30671 Stephenson Hwy Ste D, Madison Heights, MI 48071-1635 | 2019-07-09 |
| 1609340215 | Michigan Orthopedic Spine & Interventionalist Pllc | Clinic/Center | 17290 Stonebrook Dr, Northville, MI 48168-4324 | 2019-01-16 |
| 1992204341 | Jawad A Shah Md PC | Clinic/Center | 4400 S Saginaw St Ste 1370, Flint, MI 48507-2668 | 2018-02-12 |
| 1508308750 | Mark Sobor, Md | Clinic/Center | 13560 76th St, Unit 2, South Haven, MI 49090-9483 | 2016-11-04 |
| 1316316771 | Advanced Rehab and Pain Management PC | Clinic/Center | 1820 Oak Ave, Muskegon, MI 49442-2408 | 2015-09-16 |
| 1154717106 | Excellent Pain Consultants | Clinic/Center | 15565 Northland Dr W Ste 304, Southfield, MI 48075-5313 | 2015-04-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.