Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4704068901 | MI |
NPI | 1083760193 |
---|---|
Provider Name | Ms. Rose Terese St. Martin |
First Address | Chatham, MI 49816-9638 |
Second Address | Chatham, MI 49816-9638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |