Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 5101015505 | MI |
NPI | 1093934267 |
---|---|
Provider Name | Julie Wilson |
First Address | Grand Rapids, MI 49525-7051 |
Second Address | Grand Rapids, MI 49525-7051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 24/09/2015 |