Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704186866 | MI |
NPI | 1023365954 |
---|---|
Provider Name | Mrs. Megan G. Irwin |
First Address | Detroit, MI 48201-1916 |
Second Address | Detroit, MI 48201-1916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2012 |
Last Update Date | 03/11/2012 |