Individual
MARY TANISHA BURKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12854 HICKORY ST, DETROIT, MI 48205-3412
(313) 782-6631
Mailing address
12854 HICKORY ST, DETROIT, MI 48205-3412
(313) 782-6631
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
B620587785544
MI
Other
Enumeration date
10/08/2024
Last updated
10/08/2024
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