Individual
MARIA MANTUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
550 GODDARD ST, WYANDOTTE, MI 48192-2969
(313) 550-3658
Mailing address
550 GODDARD ST, WYANDOTTE, MI 48192-2969
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704371833
MI
Other
Enumeration date
01/16/2023
Last updated
01/16/2023
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