Healthcare Provider Details

I. General information

NPI: 1649746710
Provider Name (Legal Business Name): MRS. ROXANE ESKRIDGE-GARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29217 FORD RD STE 115
GARDEN CITY MI
48135-2890
US

IV. Provider business mailing address

46036 MICHIGAN AVE STE 230
CANTON MI
48188-2304
US

V. Phone/Fax

Practice location:
  • Phone: 734-833-8979
  • Fax: 734-956-6362
Mailing address:
  • Phone: 734-833-8979
  • Fax: 734-956-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703079817
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: