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1700639101
SHANISE YVONNE PETTICORD
DETROIT, MI
NPI
1700639101
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
164W00000X Licensed Practical Nurse
(Licence: MI 4703091434)
Enumeration Date
2024-04-08
Last Update Date
2024-04-08
Business Address
SHANISE YVONNE PETTICORD
5736 AUDUBON RD
DETROIT, MI 48224-2665
Phone number: 313-624-1067
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Mailing Address
SHANISE YVONNE PETTICORD
5736 AUDUBON RD
DETROIT, MI 48224-2665
Phone number: 313-624-1067
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