Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704255530 | MI |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 4704255530 | MI |
NPI | 1316335003 |
---|---|
Provider Name | Dr. Marlena Didonato Vyas |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-4254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2015 |
Last Update Date | 27/02/2017 |