Provider Demographics
NPI:1053717728
Name:MUMIRA, CAROLINE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:MUMIRA
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 1:31175 PORTSIDE DR
Mailing Address - Street 2:APT 10207
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-4267
Mailing Address - Country:US
Mailing Address - Phone:989-493-4934
Mailing Address - Fax:
Practice Address - Street 1:31175 PORTSIDE DR
Practice Address - Street 2:APT 10207
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-4267
Practice Address - Country:US
Practice Address - Phone:989-493-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703101164164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse