# JOHN D. DINGELL VA MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346954930
- **Authorized official:** MARIA ANTOINETTE HICKS LPN (TELEHEALTH COORDINATOR)
- **Authorized official phone:** (313) 576-1000

## Contact information

- **Practice address:** 4646 JOHN R ST, DETROIT, MI 48201-1916
- **Practice address phone:** (313) 576-1000
- **Mailing address:** 4646 JOHN R ST, DETROIT, MI 48201-1916
- **Mailing address phone:** (313) 576-1000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 164W00000X | Licensed Practical Nurse | — | NULL | Yes |
| 164W00000X | Licensed Practical Nurse | — | — | Yes |

## Other

- **Enumeration date:** 01/09/2023
- **Last updated:** 01/09/2023