Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704200253 | MI |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 4704200253 | MI |
NPI | 1013928860 |
---|---|
Provider Name | Mrs. Maria Carolina Donnelly |
First Address | Flint, MI 48503-2445 |
Second Address | Flint, MI 48503-2421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 14/08/2019 |