Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704200885 | MI |
NPI | 1003935743 |
---|---|
Provider Name | Kathy E Halabicky |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 21/03/2012 |