Individual
MARY DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
37520 HARPER AVE APT 107, CLINTON TWP, MI 48036-3077
(313) 208-5882
Mailing address
37520 HARPER AVE APT 107, CLINTON TWP, MI 48036-3077
(313) 208-5882
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703011830
MI
Other
Enumeration date
07/18/2016
Last updated
07/18/2016
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