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General NPI Number Information
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NPI Number | 1518139997
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Entity Type | Individual
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Provider Name | LARHONDA NICOLE TRIBBLE OWNER
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Gender | Female
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 15810 LAKESIDE VILLAGE DR APT. 205
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6118
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Country | US
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Telephone | 586-876-2298
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Fax | 586-421-4637
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Provider Business Mailing Address
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Address Line | 15810 LAKESIDE VILLAGE DR APT. 205
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6118
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Country | US
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Telephone | 586-876-2298
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Fax | 586-421-4637
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | T614488630898
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License Number State | MI
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