Individual
MRS. HAZEL ROJO FAELLACI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5711 JACKSON AVE, LAKE, MI 48632-8932
(906) 630-2789
Mailing address
5711 JACKSON AVE, LAKE, MI 48632-8932
(906) 630-2789
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703099266
MI
Other
Enumeration date
10/12/2018
Last updated
10/12/2018
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