Provider Demographics
NPI:1134634629
Name:HARBIN, ROSLENE
Entity Type:Individual
Prefix:
First Name:ROSLENE
Middle Name:
Last Name:HARBIN
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 1:31674 SCHOENHERR RD APT G-14
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-1928
Mailing Address - Country:US
Mailing Address - Phone:313-768-8677
Mailing Address - Fax:
Practice Address - Street 1:8033 E 10 MILE RD STE 114
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1454
Practice Address - Country:US
Practice Address - Phone:586-756-6661
Practice Address - Fax:586-756-6933
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703102256164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse