Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704195342 | MI |
NPI | 1003806688 |
---|---|
Provider Name | Dianne Junior |
First Address | Flint, MI 48507-3161 |
Second Address | Flint, MI 48507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 06/05/2019 |