| NPI | 1407451941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOELLE WENDEL Administrator 517-902-1102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2020-12-02 |