Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 55555 | MI |
NPI | 1881126050 |
---|---|
Provider Name | Cortney Manser |
First Address | Pleasant Lake, MI 49272-9737 |
Second Address | Pleasant Lake, MI 49272-9737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2017 |
Last Update Date | 28/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
555555 | (05) | MI |