Individual
MIA TOLBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18631 STAHELIN AVE, DETROIT, MI 48219-2821
(313) 450-5257
Mailing address
18631 STAHELIN AVE, DETROIT, MI 48219-2821
(313) 450-5257
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703116427
MI
Other
Enumeration date
06/24/2016
Last updated
06/24/2016
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