Individual
MISS LENIA KAY SNODDERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12168 CHURCHILL AVE, SOUTHGATE, MI 48195-2392
(313) 316-0428
Mailing address
11109 CELIA RD, CARLETON, MI 48117-9314
(734) 512-6090
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
5317
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5317
DOMUS VITA
MI
Enumeration date
07/07/2015
Last updated
07/07/2015
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