Individual
SHAMIKKA TASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9910 VAUGHAN ST, DETROIT, MI 48228-1334
(313) 544-8603
Mailing address
9910 VAUGHAN ST, DETROIT, MI 48228-1334
(313) 544-8603
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703115324
MI
Other
Enumeration date
02/21/2017
Last updated
02/22/2017
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