Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174V00000X | Clinical Ethicist | 1041C0700X | MI |
NPI | 1073920500 |
---|---|
Provider Name | Lashawnda Starks |
First Address | Detroit, MI 48202 |
Second Address | Detroit, MI 48202-2142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2014 |
Last Update Date | 16/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000 | (05) | MI |