Individual
MYESHA FENNICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
605 WEST BROCKTON AVENUE, MADISON HEIGHTS, MI 48071-3919
(248) 825-5401
Mailing address
605 WEST BROCKTON AVENUE, MADISON HEIGHTS, MI 48071-3919
(248) 825-5401
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703110153
MI
Other
Enumeration date
07/11/2016
Last updated
07/11/2016
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