Individual
LAVONA ANGELA WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28925 GLENWOOD ST, INKSTER, MI 48141
(313) 461-8691
Mailing address
28925 GLENWOOD ST, INKSTER, MI 48141-1625
(313) 461-8691
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
01/20/2021
Last updated
06/08/2021
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