Individual
LATISHIA EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23050 WEBSTER ST, OAK PARK, MI 48237-2119
(313) 334-1012
Mailing address
23050 WEBSTER ST, OAK PARK, MI 48237-2119
(313) 334-1012
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
47030394003
MI
Other
Enumeration date
06/01/2015
Last updated
06/01/2015
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