Individual
MS. DORA CHANNEL GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
6309 MACK AVE, DETROIT, MI 48207-2302
(248) 773-6967
Mailing address
6309 MACK AVE, DETROIT, MI 48207-2302
(248) 773-6967
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704419933
MI
164W00000X
Licensed Practical Nurse
4703094401
MI
Other
Enumeration date
07/31/2017
Last updated
10/17/2024
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