Individual
MIA WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
51291 VILLAGE EDGE E APT 202, CHESTERFIELD, MI 48047-3516
(313) 520-3064
Mailing address
51291 VILLAGE EDGE E APT 202, CHESTERFIELD, MI 48047-3516
(313) 520-3064
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703109374
MI
Other
Enumeration date
02/18/2015
Last updated
02/18/2015
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