Provider Demographics
NPI:1871319327
Name:CODY, SONTA (LPN NURSE)
Entity type:Individual
Prefix:
First Name:SONTA
Middle Name:
Last Name:CODY
Suffix:
Gender:F
Credentials:LPN NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15575 LAKESIDE VILLAGE DR APT 305
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6024
Mailing Address - Country:US
Mailing Address - Phone:313-929-5432
Mailing Address - Fax:
Practice Address - Street 1:15575 LAKESIDE VILLAGE DR APT 305
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6024
Practice Address - Country:US
Practice Address - Phone:313-929-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703126744164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse