Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2301011089 | MI |
NPI | 1649853425 |
---|---|
Provider Name | Ms. Hope Patrice Telfer |
First Address | Kalamazoo, MI 49008-2580 |
Second Address | Kalamazoo, MI 49008-2580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2021 |
Last Update Date | 08/09/2021 |