Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 5101024516 | MI |
NPI | 1023402906 |
---|---|
Provider Name | Charles Nathaniel Nessle |
First Address | Ann Arbor, MI 48109-5718 |
Second Address | Ann Arbor, MI 48109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 30/07/2019 |