Organization
EXECUTIVE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TISCUR GWENDOLYN TAYLOR LPN (NURSE)
(800) 575-5270
Entity
Organization
Contact information
Practice address
8951 RUTHERFORD ST, DETROIT, MI 48228-2131
(800) 575-5290
Mailing address
8951 RUTHERFORD ST, DETROIT, MI 48228-2131
(800) 575-5290
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
—
Other
Enumeration date
06/28/2019
Last updated
06/28/2019
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