Individual
ANDREA NIKKO MATSUMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Mailing address
28536 LAKE PARK DR W, FARMINGTON HILLS, MI 48331-4620
(248) 921-5986
Taxonomy
Speciality
Code
Description
License number
State
163WX0200X
Oncology Registered Nurse
4704306565
MI
363LA2100X
Acute Care Nurse Practitioner
Primary
4704306565
MI
Other
Enumeration date
06/11/2019
Last updated
07/11/2019
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