Individual
MRS. LATONYA ROCHELLE CONNALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
11447 JOS CAMPAU ST, HAMTRAMCK, MI 48212-3040
(313) 365-1368
Mailing address
325 MOROSS RD, GROSSE POINTE FARMS, MI 48236-2911
(313) 886-3870
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704270676
MI
163WC0400X
Case Management Registered Nurse
4704270676
MI
163WC1500X
Community Health Registered Nurse
4704270676
MI
Other
Enumeration date
06/07/2013
Last updated
06/07/2013
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