Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704208228 | MI |
NPI | 1013382357 |
---|---|
Provider Name | Mrs. Joy Sandy |
First Address | Chicago, IL 60603-2420 |
Second Address | Burton, MI 48529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2015 |
Last Update Date | 30/06/2020 |