Individual
SHAVONNE TANKERSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1588 LONDON AVE, LINCOLN PARK, MI 48146-3522
(313) 740-0590
Mailing address
1588 LONDON AVE, LINCOLN PARK, MI 48146-3522
(313) 740-0590
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703111700
MI
Other
Enumeration date
08/18/2014
Last updated
08/18/2014
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