Individual
DOMINIQUE BUMANGLAG SULLANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
707 W MILWAUKEE ST, DETROIT, MI 48202-2943
(248) 817-7597
Mailing address
707 W MILWAUKEE ST, DETROIT, MI 48202-2943
(248) 817-7597
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
4704204783
MI
Other
Enumeration date
11/29/2022
Last updated
01/23/2024
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