Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 4704263876 | MI |
NPI | 1033463377 |
---|---|
Provider Name | Ms. Andrea Jordan Altomaro |
First Address | West Bloomfield, MI 48322-1629 |
Second Address | Roseville, MI 48066-6503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2012 |
Last Update Date | 21/01/2014 |