Individual
MA-MYLA M DEL OESTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-4325
Mailing address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-4325
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704298003
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704298003
REGISTERED NURSE
MI
Enumeration date
10/19/2022
Last updated
10/19/2022
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