Individual
LAKISHA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6397 THORNWOOD DR, BELLEVILLE, MI 48111-5158
(313) 850-7008
Mailing address
6397 THORNWOOD DR, BELLEVILLE, MI 48111-5158
(313) 850-7008
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704310121
MI
Other
Enumeration date
03/14/2016
Last updated
03/14/2016
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