Individual
WANDA BANFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15941 FAIRFIELD ST, DETROIT, MI 48238-4123
(313) 345-4310
Mailing address
9340 RUTHERFORD ST, DETROIT, MI 48228-5002
(313) 345-4310
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/12/2014
Last updated
02/12/2014
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