Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4704224847 | MI |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4704224847 | MI |
NPI | 1043467434 |
---|---|
Provider Name | Mrs. Mary Kint Petit |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2008 |
Last Update Date | 19/11/2015 |