Individual
EBONIQUE LATRICE WOODARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1402 W 14 MILE RD, CLAWSON, MI 48017-1499
(866) 389-2727
Mailing address
1402 W 14 MILE RD, CLAWSON, MI 48017-1499
(866) 389-2727
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704285459
MI
Other
Enumeration date
06/17/2019
Last updated
06/17/2019
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