Individual
MS. MARQUISA DANAE SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.A,M.B.A
Contact information
Practice address
4875 COPLIN ST, DETROIT, MI 48215-2192
(313) 822-1135
(313) 822-1157
Mailing address
274 LAKEWOOD ST, DETROIT, MI 48215-3152
(313) 822-7986
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
6803085735
MI
Other
Enumeration date
10/30/2008
Last updated
10/30/2008
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