Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 4704240269 | MI |
NPI | 1073836326 |
---|---|
Provider Name | Mrs. Heather Marie Mcclain |
First Address | Livonia, MI 48154-4655 |
Second Address | Detroit, MI 48201-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2010 |
Last Update Date | 01/03/2010 |