Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 4704242835NSA180X8 | MI |
NPI | 1205301025 |
---|---|
Provider Name | Brenda Alyce Mccrum |
First Address | Schoolcraft, MI 49087-9171 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2018 |
Last Update Date | 07/10/2020 |