Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704216807 | MI |
NPI | 1013021807 |
---|---|
Provider Name | Mrs. Marlo Arvilla Kirby |
First Address | Marshall, MI 49068-1143 |
Second Address | Marshall, MI 49068-1143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 15/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4790130 | (05) | MI |
Q56230 | (02) | MI |