Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 4704308953 | MI |
NPI | 1003448580 |
---|---|
Provider Name | Katie Ann Londos |
First Address | Saginaw, MI 48602-5303 |
Second Address | Saginaw, MI 48602-5303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2020 |
Last Update Date | 01/04/2021 |