Individual
DONNETTA MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13911 NORTHLAWN ST, DETROIT, MI 48238-2437
(313) 574-7271
Mailing address
13911 NORTHLAWN ST, DETROIT, MI 48238-2437
(313) 574-7271
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703119880
MI
Other
Enumeration date
05/11/2018
Last updated
05/11/2018
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