Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301092524 | MI |
NPI | 1043466592 |
---|---|
Provider Name | Megan Duffey Bonanni |
First Address | Grosse Pointe Farms, MI 48236-3141 |
Second Address | Detroit, MI 48235-2624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2008 |
Last Update Date | 09/03/2020 |