Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4704273686 | MI |
NPI | 1033458534 |
---|---|
Provider Name | Meghan J Visnick |
First Address | Traverse City, MI 49684-2369 |
Second Address | Traverse City, MI 49684-2369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2013 |
Last Update Date | 24/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4704273686 | LICENSE (01) | MI |