Individual
GINA MARIE LACOLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1255 N OAKLAND BLVD, WATERFORD, MI 48327-1545
(248) 599-8999
(248) 406-0107
Mailing address
523 MEADOWDALE ST, FERNDALE, MI 48220-2446
(586) 744-6794
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010201
MI
Other
Enumeration date
09/21/2020
Last updated
12/26/2024
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