Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1053640946 |
---|---|
Provider Name | Miss Jennifer S Ketchum |
First Address | Flint, MI 48507-5503 |
Second Address | Flushing, MI 48433-2439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2009 |
Last Update Date | 23/12/2009 |