Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 4704239782 | MI |
NPI | 1003274283 |
---|---|
Provider Name | Ms. Alexis Mae Punches |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-4280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2016 |
Last Update Date | 31/05/2016 |