Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2301007461 | MI |
NPI | 1467500165 |
---|---|
Provider Name | Dr. Anita Curtis-Macdonald |
First Address | Ravenna, MI 49451-9604 |
Second Address | Ravenna, MI 49451-9604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 27/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
950F150280 | (02) | MI |