Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 4704306951 | MI |
NPI | 1003464181 |
---|---|
Provider Name | Amber Marroquin |
First Address | Sylvania, OH 43560-8961 |
Second Address | Detroit, MI 48202-2689 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2019 |
Last Update Date | 31/08/2019 |