| NPI | 1275294589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CADELIA NICHOLAS Administrator 313-643-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology |
| Enumeration Date | 2022-01-08 |
| Last Update Date | 2022-01-08 |