Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | MI |
NPI | 1265108823 |
---|---|
Provider Name | Ms. Cristiana Jae Newman I |
First Address | Sterling Heights, MI 48312-6392 |
Second Address | Sterling Heights, MI 48312-6392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2021 |
Last Update Date | 23/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XYQ891832037 | BCBS (01) | MI |