Individual
SHANIA PETTICORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14944 FAIRMOUNT DR, DETROIT, MI 48205-1319
(248) 525-3316
Mailing address
14944 FAIRMOUNT DR, DETROIT, MI 48205-1319
(248) 525-3316
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
04/08/2024
Last updated
04/08/2024
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