Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 4704169490 | MI |
NPI | 1023283256 |
---|---|
Provider Name | Jill Ann Matson |
First Address | Detroit, MI 48201-2061 |
Second Address | Detroit, MI 48201-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 22/10/2020 |