NPI | 1174166052 |
---|---|
Entity Type | Organization |
Authorized Contact | BETTY ELLER Credentailing Coordinator 231-727-5211 |
Organization Subpart ? | No |
Primary Taxonomy | 261Q00000X Clinic/Center |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
207Q00000X Family Medicine | |
Enumeration Date | 2019-10-23 |
Last Update Date | 2019-10-23 |