Individual
MIA HARRIS-HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4646 JOHN R STREET, DETROIT, MI 48201
(313) 576-1000
Mailing address
4646 JOHN R ST, DETROIT, MI 48201-1916
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703125159
MI
Other
Enumeration date
12/08/2023
Last updated
12/08/2023
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