Provider Demographics
NPI:1174366645
Name:NYE, DAESHAWNA (PRC)
Entity type:Individual
Prefix:
First Name:DAESHAWNA
Middle Name:
Last Name:NYE
Suffix:
Gender:F
Credentials:PRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1548
Mailing Address - Country:US
Mailing Address - Phone:989-754-8598
Mailing Address - Fax:
Practice Address - Street 1:529 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-2002
Practice Address - Country:US
Practice Address - Phone:810-238-7226
Practice Address - Fax:810-239-5518
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist