Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704303949 | MI |
NPI | 1053832790 |
---|---|
Provider Name | Jessica Elizabeth Narrett |
First Address | West Bloomfield, MI 48323-3333 |
Second Address | Livonia, MI 48150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2017 |
Last Update Date | 03/07/2017 |