Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704310741 | MI |
NPI | 1033883723 |
---|---|
Provider Name | Elizabeth Pohl |
First Address | Grand Rapids, MI 49546-7062 |
Second Address | Grand Rapids, MI 49546-7062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2021 |
Last Update Date | 05/08/2021 |