Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 5303035015 |
NPI | 1275108490 |
---|---|
Provider Name | Melissa Belt |
First Address | Grosse Pointe, MI 48236 |
Second Address | Grosse Pointe Farms, MI 48236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2021 |
Last Update Date | 20/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07111983 | PERSONAL (01) |