Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704255241 | MI |
NPI | 1023634615 |
---|---|
Provider Name | Casandra Jane Newland |
First Address | Petoskey, MI 49770-2274 |
Second Address | Petoskey, MI 49770-2274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2020 |
Last Update Date | 15/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4704255241 | STATE LICENSE (01) | MI |