Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156F00000X | Technician/Technologist |
NPI | 1154841203 |
---|---|
Provider Name | Jennifer Eve Maxbauer |
First Address | Bingham Farms, MI 48025-2453 |
Second Address | Bingham Farms, MI 48025-2453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2017 |
Last Update Date | 20/06/2017 |