Individual
TAMIKA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11320 STUDEBAKER AVE, WARREN, MI 48089-2536
(734) 545-2192
Mailing address
11320 STUDEBAKER AVE, WARREN, MI 48089-2536
(734) 545-2192
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703113082
MI
Other
Enumeration date
12/14/2015
Last updated
12/14/2015
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