Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 4704119224 | MI |
Y | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | 4704119224 | MI |
NPI | 1063482537 |
---|---|
Provider Name | Debbera J Speeter |
First Address | Kalamazoo, MI 49009-9423 |
Second Address | Kalamazoo, MI 49009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 28/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
(D) 4500712 | (05) | MI |
4500721 | (05) | MI |