Individual
CHERYL LEE IVIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
26650 EUREKA RD SUITE C, TAYLOR, MI 48180
(734) 941-4991
(734) 941-4919
Mailing address
1037 16TH STREET, WYANDOTTE, MI 48192
(248) 787-1768
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
4704248024
MI
363LG0600X
Gerontology Nurse Practitioner
4704248024
MI
Other
Enumeration date
03/01/2018
Last updated
03/01/2018
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