Individual
THERESA MCCOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13029 GEORGIANA AVE, WARREN, MI 48089-3279
(313) 736-6820
Mailing address
13029 GEORGIANA AVE, WARREN, MI 48089-3279
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703109195
MI
Other
Enumeration date
04/14/2017
Last updated
04/14/2017
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