Individual
MRS. TIA DOMINIQUE AGBORUCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20418 BINDER ST, DETROIT, MI 48234-1913
(313) 333-4038
Mailing address
20418 BINDER ST, DETROIT, MI 48234-1913
(313) 333-4038
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704311021
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704311021
MI
367500000X
Certified Registered Nurse Anesthetist
APRN.CRNA.0021121
OH
Other
Enumeration date
09/20/2021
Last updated
10/07/2024
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