Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704234219 | MI |
NPI | 1013459320 |
---|---|
Provider Name | Amy Storey |
First Address | Port Huron, MI 48060-3511 |
Second Address | Port Huron, MI 48060-3511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2016 |
Last Update Date | 17/11/2016 |