Individual
DETRA DAVIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
23161 SUSSEX ST, OAK PARK, MI 48237-2495
(313) 658-7300
Mailing address
23161 SUSSEX ST, OAK PARK, MI 48237-2495
(313) 658-7300
(248) 808-6628
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
AS630283826
MI
Other
Enumeration date
07/14/2016
Last updated
07/14/2016
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