Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife |
NPI | 1154996130 |
---|---|
Provider Name | Andrea N Pellerin |
First Address | Bay City, MI 48706-8714 |
Second Address | Saginaw, MI 48602-4323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2021 |
Last Update Date | 23/05/2021 |