Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD012986 | MI |
NPI | 1205840782 |
---|---|
Provider Name | Maureen L Dailey |
First Address | Detroit, MI 48267-2853 |
Second Address | Warren, MI 48093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114792439 | (05) | MI |
H15963 | (02) |