Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704242640 | MI |
NPI | 1003228040 |
---|---|
Provider Name | Mrs. Bridget Young |
First Address | Tawas City, MI 48764-0779 |
Second Address | Vassar, MI 48768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2014 |
Last Update Date | 06/04/2021 |