Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 4704127539 | MI |
NPI | 1114145141 |
---|---|
Provider Name | Janice L Mcallister |
First Address | Traverse City, MI 49684-2369 |
Second Address | Traverse City, MI 49684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 20/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3449580 | (05) | MI |
R66045 | (02) | MI |