Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704239002 | MI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 4704239002 | MI |
N | 363LC1500X | Nurse Practitioner - Community Health | 4704239002 | MI |
NPI | 1700088077 |
---|---|
Provider Name | Ms. Maria Elena Bastida |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 08/07/2020 |