Organization
QUEEN OF HEARTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS NICHOLE DEGREE LPN (LPN/OWNER)
(414) 630-0379
Entity
Organization
Contact information
Practice address
1431 WASHINGTON BLVD APT 2306, DETROIT, MI 48226-1728
(414) 630-0379
Mailing address
1431 WASHINGTON BLVD APT 2306, DETROIT, MI 48226-1728
(414) 630-0379
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
—
Other
Enumeration date
12/10/2018
Last updated
06/11/2019
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