Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 4704167051 | MI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 4704167051 | MI |
NPI | 1043261985 |
---|---|
Provider Name | Mrs. Dorothy Helen Rodriguez |
First Address | Waterford, MI 48328-1602 |
Second Address | Pontiac, MI 48342-2217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 06/01/2019 |