| NPI | 1164993119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN FRAZIER Administrator 313-405-3195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-16 |