Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 4704239926 | MI |
NPI | 1003292855 |
---|---|
Provider Name | Mrs. Neena Lee Kovalchik |
First Address | Sunfield, MI 48890 |
Second Address | Lansing, MI 48912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2015 |
Last Update Date | 04/08/2015 |