Individual
LASHARA VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3309 WESTLAKE CIR, BELLEVILLE, MI 48111-6108
(313) 424-8700
Mailing address
3309 WESTLAKE CIR, BELLEVILLE, MI 48111-6108
(313) 424-8700
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703079090
MI
Other
Enumeration date
08/03/2016
Last updated
08/03/2016
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