Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704154501 | MI |
N | 363LC1500X | Nurse Practitioner - Community Health | 4704154501 | MI |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704154501 | MI |
NPI | 1114087061 |
---|---|
Provider Name | Laura Irene Kaufman |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 24/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4270532 | (05) | MI |
P13192 | (02) | MI |