Individual
MARLA GRESHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-4836
Mailing address
18444 MIDDLESEX AVE, LATHRUP VILLAGE, MI 48076-4516
(248) 895-8689
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
4704186857
MI
Other
Enumeration date
08/01/2022
Last updated
08/01/2022
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