Individual
LARISSA PATILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
41621 W 11 MILE RD, NOVI, MI 48375-1804
(248) 299-0030
Mailing address
2780 SAGEBRUSH CIRCLE APT 101, ANN ARBOR, MI 48103
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703110078
MI
Other
Enumeration date
04/26/2013
Last updated
04/26/2013
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