Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704253344 | MI |
NPI | 1003249442 |
---|---|
Provider Name | Mrs. Elizabeth Lynne Cross |
First Address | Grand Haven, MI 49417-2472 |
Second Address | Grand Haven, MI 49417-2472 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2013 |
Last Update Date | 04/02/2016 |