Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MI |
NPI | 1013388321 |
---|---|
Provider Name | Jasmine Roberts |
First Address | Grand Rapids, MI 49548-5401 |
Second Address | Grand Rapids, MI 49548-1163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2015 |
Last Update Date | 13/10/2015 |