Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704315957 | MI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 4704315957 | MI |
NPI | 1073185997 |
---|---|
Provider Name | Elsina John |
First Address | Pontiac, MI 48341-1037 |
Second Address | Pontiac, MI 48341-1037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2021 |
Last Update Date | 12/02/2022 |