Provider Demographics
NPI:1033749387
Name:GARRETT, LACHELLE MYLINDA
Entity Type:Individual
Prefix:
First Name:LACHELLE
Middle Name:MYLINDA
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18060 GRUEBNER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3854
Mailing Address - Country:US
Mailing Address - Phone:586-480-6579
Mailing Address - Fax:
Practice Address - Street 1:18060 GRUEBNER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3854
Practice Address - Country:US
Practice Address - Phone:586-480-6579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703121716164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse