Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | ||
N | 156F00000X | Technician/Technologist | MI |
NPI | 1215511811 |
---|---|
Provider Name | Chasity Homer |
First Address | Sterling Heights, MI 48312-6392 |
Second Address | Sterling Heights, MI 48312-6392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2021 |
Last Update Date | 10/05/2021 |