Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704247592 | MI |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704247592 | MI |
NPI | 1033457650 |
---|---|
Provider Name | Mrs. Annette Marie Frendo |
First Address | Livonia, MI 48150-3397 |
Second Address | Dearborn, MI 48124-4089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2013 |
Last Update Date | 09/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12510310 | CAQH (01) | MI |