Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704319387 | MI |
NPI | 1043971369 |
---|---|
Provider Name | Ms. Mona Y Wissa |
First Address | Rochester Hills, MI 48306-3249 |
Second Address | Sterling Heights, MI 48312-2778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2022 |
Last Update Date | 08/01/2022 |