Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704136696 | MI |
NPI | 1003102963 |
---|---|
Provider Name | Catherine Ann Wenz |
First Address | Detroit, MI 48216-2200 |
Second Address | Detroit, MI 48235-3202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2011 |
Last Update Date | 21/09/2011 |