Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301079969 | MI |
N | 111NI0900X | Internist | 4301079969 | MI |
Y | 207RC0000X | Internist - Cardiovascular Disease | 4301079969 | MI |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 4301079969 | MI |
NPI | 1205954765 |
---|---|
Provider Name | Anna Manion Booher |
First Address | Grayling, MI 49738-1417 |
Second Address | Traverse City, MI 49684-2369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 13/10/2020 |