Most Relevant Information
Provider Data
| NPI Number: | 1003536996 |
| Provider Name: | BRENDA VANWALLAGHEN |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 4704154762 |
Most Important Dates
| Enumeration Date: | 08/31/2022 |
| Last Updated: | 08/31/2022 |
Provider Practice Location
27777 INKSTER RD STE 100
FARMINGTON HILLS
MI
483345312
Practice Location Phone/Fax
| Phone: | 2482990030 |
| Fax: |
Provider Mailing Location
27777 INKSTER RD STE 100
FARMINGTON HILLS
MI
483345312
Provider Mailing Phone/Fax
| Phone: | 2482990030 |
| Fax: |