Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704243678 | MI |
NPI | 1003204199 |
---|---|
Provider Name | Joshua David Schad |
First Address | Greenville, MI 48838-2136 |
Second Address | Ionia, MI 48846-8594 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2014 |
Last Update Date | 27/03/2015 |