Individual
JOHNETTA MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
16743 LINCOLN AVE, EASTPOINTE, MI 48021-3029
(313) 477-7366
Mailing address
16743 LINCOLN AVE, EASTPOINTE, MI 48021-3029
(313) 477-7366
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704427375
MI
164W00000X
Licensed Practical Nurse
Primary
4703121100
MI
Other
Enumeration date
12/26/2020
Last updated
07/15/2025
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