Most Relevant Information
Provider Data
| NPI Number: | 1003269952 |
| Provider Name: | NIQUITISHA EDMONDS |
| Entity Type: | Individual |
| Taxonomy Code: | 247200000X |
| Specialty: | Technician, Other |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/15/2016 |
| Last Updated: | 07/15/2016 |
Provider Practice Location
22363 WOHLFEIL ST
TAYLOR
MI
481807203
Practice Location Phone/Fax
| Phone: | 7348461570 |
| Fax: |
Provider Mailing Location
22363 WOHLFEIL ST
TAYLOR
MI
481807203
Provider Mailing Phone/Fax
| Phone: | 7348461570 |
| Fax: |