Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 4704153550 | MI |
NPI | 1023055019 |
---|---|
Provider Name | Lisa Binns-Emerick |
First Address | Troy, MI 48083-1138 |
Second Address | Detroit, MI 48201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 14/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0866595 | BCBSM PROVIDER# (01) | MI |
P32180016 | MEDICARE PTAN# (01) | MI |