Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704285953 | MI |
NPI | 1003392895 |
---|---|
Provider Name | Mikayla Spica |
First Address | Berkley, MI 48072-1485 |
Second Address | Detroit, MI 48202-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2018 |
Last Update Date | 08/12/2021 |