| NPI | 1265832026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI MARTIN Insurance Credentialing Specialist 906-776-5705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704233146) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2014-08-29 |