Individual
STACEY NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICENSED NURSE
Contact information
Practice address
2634 PEARL ST, DETROIT, MI 48209-3700
(313) 300-4691
Mailing address
PO BOX 118, S ROCKWOOD, MI 48179-0118
(248) 747-3100
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703086453
MI
Other
Enumeration date
04/11/2012
Last updated
04/11/2012
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