Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704311141 | MI |
NPI | 1013504133 |
---|---|
Provider Name | Mrs. Samantha Neely |
First Address | Newport, MI 48166-9701 |
Second Address | Grosse Pointe, MI 48230-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2020 |
Last Update Date | 22/12/2020 |