Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 4704284096NSA190T4 | MI |
NPI | 1497396162 |
---|---|
Provider Name | Mary Placido |
First Address | Southfield, MI 48033-3849 |
Second Address | Dearborn, MI 48124-4089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2019 |
Last Update Date | 22/01/2021 |