Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704244429 | MI |
NPI | 1053882043 |
---|---|
Provider Name | Heather Bowers |
First Address | Sunfield, MI 48890-9784 |
Second Address | Lansing, MI 48910-3022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2018 |
Last Update Date | 17/12/2018 |