Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 4704260563 | MI |
N | 363LG0600X | Nurse Practitioner - Gerontology | 4704260563 | MI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 4704260563 | MI |
NPI | 1083156087 |
---|---|
Provider Name | Karma Maxwell |
First Address | Lake Orion, MI 48360-1574 |
Second Address | Lake Orion, MI 48360-1574 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2016 |
Last Update Date | 08/11/2016 |