Individual
AMICAH DESIRAY TOLBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17608 GATEWAY CIR, SOUTHFIELD, MI 48075-4718
(248) 238-9195
Mailing address
17608 GATEWAY CIR, SOUTHFIELD, MI 48075-4718
(248) 238-9195
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703112807
MI
Other
Enumeration date
03/20/2019
Last updated
03/20/2019
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