Individual
KEOVIENGKHONE MERINA HAKVONGSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
22201 MOROSS RD, SUITE 150, DETROIT, MI 48236-2169
(586) 247-4300
(586) 532-6496
Mailing address
45640 SCHOENHERR RD, SUITE B, SHELBY TOWNSHIP, MI 48315-6033
(586) 247-4300
(586) 532-6496
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704212195
MI
Other
Enumeration date
09/21/2006
Last updated
01/08/2015
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