Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 430568 | NY |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704311116 | MI |
NPI | 1023311057 |
---|---|
Provider Name | Erin Boumansour |
First Address | Ann Arbor, MI 48103-8944 |
Second Address | Ann Arbor, MI 48103-8944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2010 |
Last Update Date | 24/02/2021 |