Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 4704293061 | MI |
NPI | 1033636188 |
---|---|
Provider Name | Michelle Neyer |
First Address | Monroe, MI 48161-9754 |
Second Address | Monroe, MI 48161-0726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2017 |
Last Update Date | 29/08/2017 |