| NPI | 1104900455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY RATOWSKI Director Provider Affairs 248-703-2003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 830190) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2024-03-06 |