Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 4704234681 | MI |
NPI | 1043539562 |
---|---|
Provider Name | Ms. Carmen L Rancilio |
First Address | Chesterfield, MI 48051-3239 |
Second Address | Detroit, MI 48201-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2010 |
Last Update Date | 10/10/2017 |