Individual
IMAOBONG IBOKETTE VANDERPOOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
17256 ROSELAND BLVD, SOUTHFIELD, MI 48076-2823
(248) 388-0881
Mailing address
17256 ROSELAND BLVD, SOUTHFIELD, MI 48076-2823
(248) 388-0881
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
4704313471
MI
Other
Enumeration date
09/05/2019
Last updated
09/05/2019
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