Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704273155 | MI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 4704273155 | MI |
NPI | 1053770305 |
---|---|
Provider Name | Mrs. Katie Elizabeth Simkow |
First Address | Farmington Hills, MI 48334-2052 |
Second Address | Westland, MI 48185-1149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2016 |
Last Update Date | 15/02/2016 |