Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301076142 | MI |
NPI | 1003811589 |
---|---|
Provider Name | Dr. Nicole S Boxer |
First Address | Boston, MA 02109-1827 |
Second Address | Battle Creek, MI 49037-2963 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 11/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
45306050 | (05) | MI |
H85129 | (02) | MI |