Individual
FAIRY QUEEN ENRIQUEZ SIEKIERKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
3990 JOHN R ST, DETROIT, MI 48201-2018
(313) 745-5111
(313) 745-3500
Mailing address
20334 OPORTO AVE, LIVONIA, MI 48152-1891
(248) 378-0172
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704328579
MI
Other
Enumeration date
09/01/2023
Last updated
11/06/2024
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