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Individual

TRAVELL DENEISE JOHNSON-PETTWAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-1000
Mailing address
18504 DOLORES AVE, LATHRUP VILLAGE, MI 48076-2682
(313) 820-3449

Taxonomy

Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
4704202831
MI

Other

Enumeration date
07/13/2022
Last updated
07/13/2022
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