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 |