Individual
REGENA YVETTE WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11677 MANSFIELD ST, DETROIT, MI 48227-1170
(313) 918-5835
Mailing address
11677 MANSFIELD ST, DETROIT, MI 48227-1170
(313) 918-5835
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
112227
MI
Other
Enumeration date
04/09/2021
Last updated
04/09/2021
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