Individual
GEORGIANA ALBERTA DECLERCQ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1001 S RAISINVILLE RD, MONROE, MI 48161-9754
(734) 384-0058
Mailing address
624 PEARL ST, DUNDEE, MI 48131-1018
(734) 384-0058
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704280092
MI
Other
Enumeration date
04/11/2013
Last updated
04/11/2013
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