| NPI | 1467454199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH PERESS Vice President Student Affairs 906-635-2634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2008-12-12 |