Individual
SHERONDA LANETTA BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
13929 HARPER AVE., DETROIT, MI 48213
(313) 371-0055
(313) 469-7072
Mailing address
13929 HARPER AVE, DETROIT, MI 48213-3672
(313) 371-0055
(313) 469-7072
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703080391
MI
Other
Enumeration date
08/27/2020
Last updated
08/27/2020
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