Individual
TRACEY OLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19150 EDGEFIELD ST, GROSSE POINTE, MI 48236-2020
(313) 675-5676
Mailing address
19150 EDGEFIELD ST, GROSSE POINTE, MI 48236-2020
(313) 675-5676
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703100824
MI
Other
Enumeration date
04/19/2016
Last updated
04/19/2016
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