Healthcare Provider Details

I. General information

NPI: 1952536153
Provider Name (Legal Business Name): LISA GARRETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3823 31ST ST
DETROIT MI
48210-3117
US

IV. Provider business mailing address

3823 31ST ST
DETROIT MI
48210-3117
US

V. Phone/Fax

Practice location:
  • Phone: 313-894-0947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704197011
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: