Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 4301111782 | MI |
NPI | 1003101429 |
---|---|
Provider Name | Dr. Erin Megan Pettijohn |
First Address | Grand Rapids, MI 49546-7062 |
Second Address | Grand Rapids, MI 49503-4608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 13/03/2020 |