Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1235808973 |
---|---|
Provider Name | Amy Michelle Prather |
First Address | Southgate, MI 48195-3047 |
Second Address | Southgate, MI 48195-3047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2021 |
Last Update Date | 08/09/2021 |