Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 4704164005 | MI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 4704164005 | MI |
NPI | 1053551812 |
---|---|
Provider Name | Ms. Deborah Susan Hochberg |
First Address | Detroit, MI 48202-2608 |
Second Address | Detroit, MI 48202-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2009 |
Last Update Date | 05/03/2021 |