Individual
CHANTILLE LUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
27817 YVETTE DR, WARREN, MI 48088-6647
(313) 544-8101
Mailing address
27817 YVETTE DR, WARREN, MI 48088-6647
(313) 544-8101
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
230014969350410
MI
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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