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Individual

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Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
4273 CORPORATE DR, MT PLEASANT, MI 48858-5321
(989) 953-4357
Mailing address
4273 CORPORATE DR, MT PLEASANT, MI 48858-5321

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703125777
MI

Other

Enumeration date
12/08/2022
Last updated
12/08/2022
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