Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 4704177746 | MI |
NPI | 1003381062 |
---|---|
Provider Name | Kelly A Hammill |
First Address | Ann Arbor, MI 48103-2063 |
Second Address | Ann Arbor, MI 48104-1413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2018 |
Last Update Date | 05/10/2018 |