Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101026481 | MI |
Y | 207Q00000X | Family Doctor | 5101026481 | MI |
NPI | 1245768951 |
---|---|
Provider Name | Erin Nicole Deprekel |
First Address | Iron Mountain, MI 49801-9419 |
Second Address | Iron Mountain, MI 49801-3649 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2017 |
Last Update Date | 30/09/2021 |