Individual
MISS LANISHA ANTOINETTE BLEVINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE
Contact information
Practice address
1574 W RIVER PARK DR, INKSTER, MI 48141-1836
(313) 758-8362
Mailing address
1574 W RIVER PARK DR, INKSTER, MI 48141-1836
(313) 758-8362
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
1492119
MI
Other
Enumeration date
11/23/2020
Last updated
12/16/2020
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