Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4123-33 | WI |
NPI | 1053631564 |
---|---|
Provider Name | Ms. Michelle Lynn Maki |
First Address | Green Bay, WI 54307-9070 |
Second Address | Green Bay, WI 54301-2253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2010 |
Last Update Date | 26/10/2016 |