Individual
BROOKE WANSHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RN, CPNP-PC
Contact information
Practice address
2331 MONROE ST, DEARBORN, MI 48124-3009
(734) 673-1560
Mailing address
11022 HILLCREST ST, LIVONIA, MI 48150-2922
(734) 673-1560
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704296967
MI
Other
Enumeration date
06/07/2016
Last updated
06/07/2016
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