Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4301079739 | MI |
N | 207VG0400X | Gynecologist | 4301079739 | MI |
N | 207VX0000X | Obstetrician | 4301079739 | MI |
NPI | 1134214547 |
---|---|
Provider Name | Breanna M Pond |
First Address | Marquette, MI 49855 |
Second Address | Marquette, MI 49855 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I42185 | (02) | MI |