Individual
MS. SHELLEY ANTONUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
17187 SCHAEFER HWY, DETROIT, MI 48235-4132
(313) 960-6605
(248) 595-8269
Mailing address
355 TYLER ROAD, LASALLE, ONTARIO N9J3X-2
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704261629
MI
Other
Enumeration date
02/15/2019
Last updated
02/15/2019
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