Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704260884 | MI |
NPI | 1053833269 |
---|---|
Provider Name | Jarida Begum |
First Address | Taylor, MI 48180-3322 |
Second Address | Hamtramck, MI 48212-3307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2017 |
Last Update Date | 11/01/2021 |