Individual
THERESA COLVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2766 W 11 MILE RD, OAK PARK, MI 48273
(800) 352-5340
Mailing address
1448 E HARRY AVE, HAZEL PARK, MI 48030-2110
(248) 727-3530
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703113465
MI
Other
Enumeration date
06/23/2016
Last updated
06/23/2016
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