Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101021343 | MI |
NPI | 1003233453 |
---|---|
Provider Name | Dr. Jennifer Carlton |
First Address | Washington, MI 48095-2811 |
Second Address | Washington, MI 48095-2811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 17/03/2018 |