Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2301010197 | MI |
NPI | 1174966790 |
---|---|
Provider Name | Jeng-Li Lily Semrow |
First Address | Holland, MI 49423-9257 |
Second Address | Holland, MI 49423-9257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2013 |
Last Update Date | 22/08/2014 |