Individual
CAROLE ANN TENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1016 PELHAM BLVD, WATERFORD, MI 48328-4253
(124) 868-1025
Mailing address
1016 PELHAM BLVD # 1, WATERFORD, MI 48328-4253
(248) 681-0250
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704098952
MI
Other
Enumeration date
04/05/2018
Last updated
04/05/2018
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