Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 202018948 | MI |
NPI | 1033881636 |
---|---|
Provider Name | Ms. Marissa Renee Sevenish |
First Address | Ann Arbor, MI 48105-9484 |
Second Address | Chelsea, MI 48118-1434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2021 |
Last Update Date | 27/12/2021 |