Active NPI
Mary Tanisha Burks
- Personal Care Attendant
- Detroit, MI
National Provider Identifier
1750100509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Personal Care Attendant
- License
- B620587785544
- Practice address
- 12854 Hickory St
Detroit, MI 48205-3412 - Phone
- (313) 782-6631
- NPI assigned
- Oct 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | B620587785544 | MI | Primary |
Addresses
Primary practice location
12854 Hickory St
Detroit, MI 48205-3412
Mailing address
12854 Hickory St
Detroit, MI 48205-3412
Phone (313) 782-6631
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B620587785544 | MI | MD | Personal Care Attendant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728345600000",
"number": "1750100509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12854 HICKORY ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482053412",
"telephone_number": "313-782-6631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12854 HICKORY ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482053412",
"telephone_number": "313-782-6631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURKS",
"first_name": "MARY",
"middle_name": "TANISHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-08",
"last_updated": "2024-10-08",
"certification_date": "2024-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "3747P1801X",
"taxonomy_group": "",
"desc": "Technician, Personal Care Attendant",
"state": "MI",
"license": "B620587785544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.