Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301119210 | MI |
Y | 2080P0203X | Pediatric Critical Care Doctor | 4301119210 | MI |
NPI | 1083058184 |
---|---|
Provider Name | Erica Andrist |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2013 |
Last Update Date | 30/01/2020 |