Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MT220489 | PA |
NPI | 1003430760 |
---|---|
Provider Name | Michelle K Xu |
First Address | Erie, PA 16544-0002 |
Second Address | Erie, PA 16544-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2020 |
Last Update Date | 28/05/2020 |