Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1144730037 |
---|---|
Provider Name | Colleen Nicole Rowland |
First Address | Southgate, MI 48195-1426 |
Second Address | Southgate, MI 48195-2507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2017 |
Last Update Date | 04/10/2017 |