Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704266184 | MI |
NPI | 1003204660 |
---|---|
Provider Name | Beverlie Houser |
First Address | Fort Gratiot, MI 48059-3882 |
Second Address | Fort Gratiot, MI 48059-3882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2015 |
Last Update Date | 06/01/2015 |