Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101012812 | MI |
NPI | 1043228653 |
---|---|
Provider Name | Dr. Jennifer Lee Gilmore |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48823-5376 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 13/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043228653 | (05) | MI |
4219066 | (05) | MI |
H21704 | (02) | MI |