Individual
QIANA TENE MATTHEWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4007 12TH ST, ECORSE, MI 48229-1305
(313) 624-7182
Mailing address
4007 12TH ST # 400712TH, ECORSE, MI 48229-1305
(313) 624-7182
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703121451
MI
Other
Enumeration date
07/01/2025
Last updated
07/01/2025
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