Individual
LAUREN ELIZABETH FAVAZZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2421 MONROE ST STE 201, DEARBORN, MI 48124-3043
(313) 914-3260
Mailing address
14052 CRANSTON ST, LIVONIA, MI 48154-4249
(734) 536-4332
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010317
MI
Other
Enumeration date
11/14/2020
Last updated
11/14/2020
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