Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | F3418861 | NY |
NPI | 1083135875 |
---|---|
Provider Name | Mrs. Grace Margaret Michel |
First Address | Camillus, NY 13031-2204 |
Second Address | Syracuse, NY 13205-2548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2017 |
Last Update Date | 30/06/2017 |