Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 4704177424 | MI |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704177424 | MI |
NPI | 1083966220 |
---|---|
Provider Name | Mrs. Donna S. Beal-Lloyd |
First Address | Southfield, MI 48075-7137 |
Second Address | Detroit, MI 48202-1732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2012 |
Last Update Date | 26/08/2016 |