Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704325886 | MI |
NPI | 1033883947 |
---|---|
Provider Name | Melissa Mobley |
First Address | Macomb, MI 48042-2845 |
Second Address | Macomb, MI 48042-2845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2021 |
Last Update Date | 04/08/2021 |