Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 5501016473 | MI |
NPI | 1194227314 |
---|---|
Provider Name | Nanette Hannum |
First Address | Detroit, MI 48202-2608 |
Second Address | Detroit, MI 48202-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2018 |
Last Update Date | 03/03/2018 |