Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | HB138254 | MI |
NPI | 1003809351 |
---|---|
Provider Name | Harriet Sue Barner |
First Address | Traverse City, MI 49684-1364 |
Second Address | Traverse City, MI 49684-3198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 28/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4390227 | (05) | MI |