Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1316502933 |
---|---|
Provider Name | Elaina Suzanne Walling |
First Address | East Lansing, MI 48823-9715 |
Second Address | East Lansing, MI 48823-9715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2019 |
Last Update Date | 08/05/2019 |