Individual
LATOYA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17301 ANNCHESTER RD, DETROIT, MI 48219-3526
(313) 244-2991
Mailing address
4646 JOHN R ST, DETROIT, MI 48201-1916
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703105645
MI
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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