Individual
CARLA PORTILLO-MEDRANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5635 W FORT ST, DETROIT, MI 48209-3154
(734) 968-2566
Mailing address
5635 W FORT ST, DETROIT, MI 48209-3154
(734) 968-2566
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704324069
MI
363LF0000X
Family Nurse Practitioner
Primary
4704324069
MI
Other
Enumeration date
02/05/2021
Last updated
04/24/2025
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