Individual
MRS. THERESA ANN WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
37605 PEMBROKE AVE, LIVONIA, MI 48152-1050
(734) 591-7931
(734) 464-0335
Mailing address
37605 PEMBROKE AVE, LIVONIA, MI 48152-1050
(734) 591-7931
(734) 464-0335
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601004027
MI
Other
Enumeration date
06/10/2009
Last updated
06/10/2009
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