Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 209014176 | IL |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 4704356317 | MI |
NPI | 1558717330 |
---|---|
Provider Name | Annmarie D Egan |
First Address | Traverse City, MI 49684-2360 |
Second Address | Traverse City, MI 49684-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2016 |
Last Update Date | 25/08/2020 |