Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704159580 | MI |
NPI | 1063596070 |
---|---|
Provider Name | Ms. Wendy Katherine Lemere |
First Address | Detroit, MI 48202-2608 |
Second Address | Taylor, MI 48180-3322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P10091 | (02) | MI |