Individual
ATHENA T LAVENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19905 WASHTENAW ST, HARPER WOODS, MI 48225-2225
(313) 778-4290
Mailing address
44450 PINETREE DR STE 203, PLYMOUTH, MI 48170-3869
(734) 207-8316
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703098328
MI
Other
Enumeration date
04/09/2018
Last updated
04/09/2018
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