Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704316352 | MI |
NPI | 1003288457 |
---|---|
Provider Name | Amy Altamash |
First Address | Temperance, MI 48182-9223 |
Second Address | Temperance, MI 48182-9223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2015 |
Last Update Date | 29/10/2015 |