Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704231510 | MI |
NPI | 1013169846 |
---|---|
Provider Name | Aimee Susan Kantzler |
First Address | Dearborn, MI 48124-4089 |
Second Address | Dearborn, MI 48124-4089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2008 |
Last Update Date | 19/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11944909 | CAQH (01) | MI |