Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704268013 | MI |
NPI | 1003287780 |
---|---|
Provider Name | Amber Nicole Mason |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2015 |
Last Update Date | 18/11/2015 |