Individual
CARLY ALLYSE FARDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-3000
Mailing address
29731 FLANDERS AVE, WARREN, MI 48088-3775
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704322732
MI
Other
Enumeration date
08/16/2024
Last updated
08/16/2024
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