Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2301007635 | MI |
NPI | 1508800152 |
---|---|
Provider Name | Dr. Ann Marie Pushies |
First Address | Williamston, MI 48895-1538 |
Second Address | Williamston, MI 48895-1538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U72634 | (02) | MI |