Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 4704348623 | MI |
N | 363L00000X | Nurse Practitioner | 4704348623 | MI |
NPI | 1013676162 |
---|---|
Provider Name | Mrs. Anna Friedrich |
First Address | Grand Rapids, MI 49546-6204 |
Second Address | Grand Rapids, MI 49546-6204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2021 |
Last Update Date | 20/12/2021 |