Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301051083 | MI |
NPI | 1093760134 |
---|---|
Provider Name | Kerry Lynne Vegter |
First Address | Lansing, MI 48909-8016 |
Second Address | Holland, MI 49423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 24/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
930001443 | RAILROAD MEDICARE (01) | MI |
E95579 | (02) |