Individual
STACEY LYNN BLACK-SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-1000
Mailing address
17515 WILDEMERE ST, DETROIT, MI 48221-2724
(313) 570-9046
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
4704282646
MI
Other
Enumeration date
04/10/2024
Last updated
04/10/2024
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