| NPI | 1184222572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELIQUE D MOORE Np 248-943-4535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2020-10-16 |
| Last Update Date | 2020-10-16 |