Individual
RENEE EDMISTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
43825 MICHIGAN AVE, CANTON, MI 48188-2551
(734) 397-3088
Mailing address
31492 MERRIWOOD PARK DR, LIVONIA, MI 48152-4232
(248) 579-6236
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703040080
MI
Other
Enumeration date
09/18/2019
Last updated
09/18/2019
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