Individual
THEODORA C GIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5555 CONNER ST, DETROIT, MI 48213-3448
(313) 687-3633
Mailing address
8900 E JEFFERSON AVE APT 215, DETROIT, MI 48214-2890
(313) 687-3633
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
08/29/2025
Last updated
08/29/2025
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