Individual
LATESA RENAE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.N.A
Contact information
Practice address
11611 GRAYTON ST, DETROIT, MI 48224-1643
(313) 556-4769
(313) 473-8192
Mailing address
11611 GRAYTON ST, DETROIT, MI 48224-1643
(313) 556-4769
(313) 473-8192
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
230109450998
MI
Other
Enumeration date
02/24/2019
Last updated
08/26/2019
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