Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 5502003992 | MI |
NPI | 1023505062 |
---|---|
Provider Name | Miss Charlotte Blair Rancour |
First Address | Saginaw, MI 48602-4316 |
Second Address | Saginaw, MI 48602-4316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2018 |
Last Update Date | 16/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
JXP913029551 | BLUE CROSS BLUE SHIELD (01) | MI |