Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1376924142 |
---|---|
Provider Name | Lois Jean Webster |
First Address | Detroit, MI 48227 |
Second Address | Detroit, MI 48227-1959 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2015 |
Last Update Date | 17/06/2015 |