Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 4301046057 | MI |
NPI | 1033219399 |
---|---|
Provider Name | Danita Lucette Peoples-Peterson |
First Address | Midland, MI 48640 |
Second Address | Midland, MI 48640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B43791 | (02) | |
DP046057 | BLUE CROSS BLUE SHIELD MI (01) |