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Individual

SHAVON CHARLESTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
43825 MICHIGAN AVE, CANTON, MI 48188-2551
(734) 397-3088
Mailing address
26845 DOVER, REDFORD, MI 48239-1919

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703105581
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
NA
MI
Enumeration date
06/05/2018
Last updated
06/05/2018
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