Individual
LAQUITA JO SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5864 HOLCOMB ST, DETROIT, MI 48213-3091
(313) 758-8122
Mailing address
5864 HOLCOMB ST, DETROIT, MI 48213-3091
(313) 758-8122
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703056770
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4703056770
LPN
MI
Enumeration date
01/25/2017
Last updated
01/25/2017
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