Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1043405871 |
---|---|
Provider Name | Leanna Bronni |
First Address | Brownstown, MI 48183-2589 |
Second Address | Brownstown, MI 48183-2589 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2007 |
Last Update Date | 14/09/2007 |