Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704269943 | MI |
NPI | 1003276197 |
---|---|
Provider Name | Michaela Coffia |
First Address | Benzonia, MI 49616-8632 |
Second Address | Frankfort, MI 49635-9003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2016 |
Last Update Date | 21/09/2016 |