| NPI | 1538756390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELIQUE DENISE MOORE Fnp 248-943-4535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2020-12-28 |
| Last Update Date | 2020-12-28 |