Individual
SHANTIQUE DORTCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
39449 DELLA ROSA DR, STERLING HEIGHTS, MI 48313-5227
(313) 870-8736
Mailing address
39449 DELLA ROSA DR, STERLING HEIGHTS, MI 48313-5227
(313) 870-8736
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703117952
MI
Other
Enumeration date
07/12/2018
Last updated
04/14/2022
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