Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 4704314139 | MI |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 4704314139 | MI |
NPI | 1164195962 |
---|---|
Provider Name | Alexandra Longnecker |
First Address | Ypsilanti, MI 48197-3214 |
Second Address | Ann Arbor, MI 48109-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2021 |
Last Update Date | 28/07/2021 |