Individual
ANDREA MICHELLE MARSHALL-DIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2925 RUSSELL ST, DETROIT, MI 48207
(313) 396-5300
Mailing address
2925 RUSSELL ST, DETROIT, MI 48207
(313) 396-5300
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
4704255578
MI
Other
Enumeration date
10/07/2019
Last updated
10/07/2019
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