Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704199950 | MI |
NPI | 1023348976 |
---|---|
Provider Name | Mrs. Michelle Carol Brogdon |
First Address | Clinton Township, MI 48038-1157 |
Second Address | Clinton Township, MI 48038-1157 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2009 |
Last Update Date | 30/03/2021 |