Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 4704087966 | MI |
NPI | 1104915263 |
---|---|
Provider Name | Ms. Sharon Ann Grix |
First Address | Fraser, MI 48026-5082 |
Second Address | Detroit, MI 48236-2148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |