Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704255971 | MI |
NPI | 1003200049 |
---|---|
Provider Name | Laura Ellen Gultekin |
First Address | Ann Arbor, MI 48109-5482 |
Second Address | Ypsilanti, MI 48198-5752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 27/03/2015 |