Individual
LOLA BASKERVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2766 W 11 MILE RD, SUITE 2, BERKLEY, MI 48072-3033
(248) 542-2424
(248) 542-5621
Mailing address
2766 W 11 MILE RD, SUITE 2, BERKLEY, MI 48072-3033
(248) 542-2424
(248) 542-5621
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704119887
MI
Other
Enumeration date
12/24/2015
Last updated
12/24/2015
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