Individual
MISS IVYE L MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MLPN
Contact information
Practice address
CITY OF DETROIT HEALTH DEPARTMENT 1151 TAYLOR, ROOM 332, DETROIT, MI 48202-1732
(313) 852-4291
(313) 368-4694
Mailing address
NORTHEAST HEALTH CENTER 5400 EAST 7 MILE, ROOM 25, DETROIT, MI 48234
(313) 852-4291
(313) 368-4694
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703063073
MI
Other
Enumeration date
07/11/2008
Last updated
07/11/2008
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