Individual
LATANYA GAYNELL MOSES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
12690 W OUTER DR, DETROIT, MI 48223-3204
(313) 244-7101
Mailing address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-1000
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703123838
MI
Other
Enumeration date
04/26/2024
Last updated
04/26/2024
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