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Individual

GABRIEL MCKINNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPN

Contact information

Practice address
14550 GRANDVILLE AVE, DETROIT, MI 48223-2231
(313) 415-6151
Mailing address
14550 GRANDVILLE AVE, DETROIT, MI 48223-2231
(313) 415-6151

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703114910
MI
372500000X
Chore Provider
374U00000X
Home Health Aide
405300000X
Prevention Professional
4703114910
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4703114910
BCBS
MI
05
4703114910
MI
Enumeration date
06/11/2019
Last updated
06/11/2019
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