Individual
MEGAN VIRGINIA DEMALLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29877 TELEGRAPH RD, SOUTHFIELD, MI 48034-1332
(248) 354-8003
Mailing address
29877 TELEGRAPH RD, SOUTHFIELD, MI 48034-1332
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704325132
MI
Other
Enumeration date
01/22/2021
Last updated
09/07/2021
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