Most Relevant Information
Provider Data
| NPI Number: | 1003392895 |
| Provider Name: | MIKAYLA SPICA NURSE PRACTITIONER |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2100X |
| Specialty: | Nurse Practitioner |
| License Number: | 4704285953 |
Most Important Dates
| Enumeration Date: | 07/14/2018 |
| Last Updated: | 12/08/2021 |
Provider Practice Location
2799 W GRAND BLVD
DETROIT
MI
482022608
Practice Location Phone/Fax
| Phone: | 3139162600 |
| Fax: |
Provider Mailing Location
4219 GARDNER AVE
BERKLEY
MI
480721485
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |