Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F08190619 | MI |
NPI | 1003458266 |
---|---|
Provider Name | Mary Beach |
First Address | Midland, MI 48640-4813 |
Second Address | Saginaw, MI 48601-4958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2019 |
Last Update Date | 24/02/2020 |