KEOVIENGKHONE MERINA HAKVONGSA (NPI# 1992804660) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992804660 |
| Entity Type | Individual |
| Full Name | KEOVIENGKHONE MERINA HAKVONGSA |
| Other Name | KEOVIENGKHONE MERINA LATIMER |
| Credential | NP |
| Practice Address |
22201 Moross Rd Suite 150 Detroit MI 48236-2169 |
| Mailing Address |
45640 Schoenherr Rd Suite B Shelby Township MI 48315-6033 |
| Practice Telephone | 5862474300 |
| Practice Fax Number | 5865326496 |
| Mailing Telephone | 5862474300 |
| Mailing Fax Number | 5865326496 |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2015-01-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
4704212195 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
22201 MOROSS RD SUITE 150 |
| City | DETROIT |
| State | MI |
| Zip Code | 48236-2169 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598760688 | Henry Grady Bone IIi | Internal Medicine | 22201 Moross Rd, Ste 260, Detroit, MI 48236-2175 | 2005-06-16 |
| 1790302396 | Zoheb Backer | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-30 |
| 1003432816 | Keerthana Reddy Banala | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd, Suite 80, Detroit, MI 48236 | 2020-06-18 |
| 1013533918 | Sajithaa Varadarasa | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-17 |
| 1578188918 | Rida Jamal | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd, Detroit, MI 48236 | 2020-06-11 |
| 1669097952 | Inderpal Singh | Internal Medicine | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-11 |
| 1376168732 | Mehdi Yavari | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd, Detroit, MI 48236 | 2020-06-11 |
| 1548884414 | Krishna Chandra Mahat | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-05 |
| 1508358540 | Vito Saracino | Internal Medicine | 22201 Moross Rd, Detroit, MI 48236-2169 | 2018-06-05 |
| 1457880718 | Marco Antonio Martinez | Obstetrics & Gynecology | 22201 Moross Rd, Suite 370, Detroit, MI 48236 | 2017-06-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093323966 | Khairya Fatouh | Pathology | 22101 Morros Road, Pathology Department, Detroit, Detroit, MI 48236 | 2020-07-16 |
| 1134744998 | Harish Harry Gidda | Internal Medicine | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-08 |
| 1770107443 | Arshan Ali Khan | Internal Medicine | 22101 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-05-29 |
| 1750901658 | Annika Van Wieren | Emergency Medicine | 22101 Moross Road, Emergency Department, Detroit, MI 48236 | 2020-04-21 |
| 1801449483 | Ishaq Azeem Asghar | Student in an Organized Health Care Education/Training Program | 22101 Moross Road, Pathology Department, Detroit, MI 48236 | 2019-07-22 |
| 1295290443 | Ascension St. John Hospital | Dietitian, Registered | 22201 Moross, Ste. 270, Detriot, MI 48236 | 2019-02-01 |
| 1548747413 | Abiodun Adenuga Adefarasin | Pharmacist | 20746 Mack Avenue, Gross Pointe Woods, MI 48236 | 2018-07-24 |
| 1629564042 | Hamza H Khan | Student in an Organized Health Care Education/Training Program | 22201 Moross, Professional Building 2, Suite 70, Detroit, MI 48236 | 2018-07-09 |
| 1235631664 | David Lee Williams | Physical Therapist | 159 Kercheval Avenue, Grosse Pointe Farms, MI 48236 | 2018-03-01 |
| 1164979720 | Memphie Morgan | Licensed Practical Nurse | 91527 Cheshire St., Grosse Pointe, MI 48236 | 2016-09-01 |
| Find all providers in zip 48236 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386243574 | Carl Andrew Ballard | Nurse Practitioner | 2635 Johnson Bottom Rd, Detroit, AL 35552-2731 | 2020-10-20 |
| 1639776164 | Jennifer N Fucile | Nurse Practitioner | 3800 Woodward Ave Apt 702, Detroit, MI 48201-1980 | 2020-10-07 |
| 1649880329 | Dedra Delane Ford | Nurse Practitioner | 18255 Birchcrest Dr, Detroit, MI 48221-2750 | 2020-08-06 |
| 1528695624 | Venvisor Health Michigan LLC | Nurse Practitioner | 400 Renaissance Ctr Ste 200, Detroit, MI 48243-1502 | 2020-03-26 |
| 1558909978 | Ruxandra Maria Lazar | Nurse Practitioner | 5285 Anthony Wayne Dr, Detroit, MI 48202-3947 | 2019-12-16 |
| 1376186460 | Fazila Mahmood Siddiqui | Nurse Practitioner | 22201 Moross Rd Bldg Suite380, Detroit, MI 48236-2169 | 2019-10-22 |
| 1205482692 | Ladawn Denise Kennedy | Nurse Practitioner | 16645 Ilene St, Detroit, MI 48221-3401 | 2019-08-13 |
| 1427600246 | Christina Neirinck | Nurse Practitioner | 2401 St Antoine St, Detroit, MI 48201 | 2019-07-11 |
| 1548821556 | Ty R Houston | Nurse Practitioner | 13100 Corbett St, Detroit, MI 48213-2081 | 2019-06-21 |
| 1235795451 | Nekisha Bailey | Nurse Practitioner | 7501 Parkland, Detroit, MI 48239-1079 | 2019-05-13 |
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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.