| NPI | 1811073901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON PHILLIPS Provider Enrollment Specialist 313-874-2892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 830190) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical | |
| 363AS0400X Physician Assistant, Surgical | |
| 363LA2100X Nurse Practitioner, Acute Care | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| 363LN0000X Nurse Practitioner, Neonatal | |
| 363LN0005X Nurse Practitioner, Neonatal, Critical Care | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| 364S00000X Clinical Nurse Specialist | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2024-09-06 |