Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1023580818 |
---|---|
Provider Name | Ajanee Makiah Grier |
First Address | Redford, MI 48239-1055 |
Second Address | Roseville, MI 48066-4426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2018 |
Last Update Date | 18/12/2018 |