Individual
NICOLE KANNETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MACP
Contact information
Practice address
27827 ONEIL ST, ROSEVILLE, MI 48066-3022
(313) 461-5218
Mailing address
27827 ONEIL ST, ROSEVILLE, MI 48066-3022
(313) 461-5218
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
11/20/2014
Last updated
11/20/2014
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