Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4704165584 | MI |
NPI | 1033210174 |
---|---|
Provider Name | Kitty Mccarthy |
First Address | Muskegon, MI 49444-3609 |
Second Address | Grand Rapids, MI 49503-4601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
KM4704165584 | (05) | MI |