| NPI | 1265220438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISTY GUNTER RUSSIAN Regional Manager, Provider Enrollme 517-253-6308 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2025-04-28 |