Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Feb 23, 2021
License(s)
4704301119 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 10140 VERNOR HWY | Dearborn, MI 48120-1515 | 313-438-6059 |
| MAILING | 10140 VERNOR HWY | Dearborn, MI 48120-1515 | 313-438-6059 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.