Individual
SHANDA A PICKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
8201 GRANDVILLE AVE, 1, DETROIT, MI 48228-3007
(248) 818-2862
Mailing address
8201 GRANDVILLE AVE, 1, DETROIT, MI 48228-3007
(248) 818-2862
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703113183
MI
Other
Enumeration date
12/05/2008
Last updated
10/25/2014
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