Individual
MILDRED THAXTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
21885 DUNHAM RD, SUITE 2, CLINTON TOWNSHIP, MI 48036-1030
(586) 783-8113
Mailing address
25605 BRUMAR ST, CHESTERFIELD, MI 48051-1914
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
L638978
MI
Other
Enumeration date
02/16/2007
Last updated
07/08/2007
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