Individual
MICA LATICE CRAIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1921 PARKCREST DR SW, APT 9, WYOMING, MI 49519-9330
(616) 634-4903
Mailing address
1921 PARKCREST DR SW, APT 9, WYOMING, MI 49519-9330
(616) 634-4903
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703094690
MI
Other
Enumeration date
08/18/2010
Last updated
08/18/2010
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