Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4704147021 | MI |
NPI | 1063687283 |
---|---|
Provider Name | Mrs. Cathleen Deburton |
First Address | East Lansing, MI 48823 |
Second Address | East Lansing, MI 48823-9320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 29/04/2008 |