Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704260334 | MI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 4704260334 | MI |
N | 363LG0600X | Nurse Practitioner - Gerontology | 4704260334 | MI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 4704260334 | MI |
NPI | 1043778699 |
---|---|
Provider Name | Natalie Gomez-Evans |
First Address | Grand Blanc, MI 48439-8065 |
Second Address | Grand Blanc, MI 48439-8065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2019 |
Last Update Date | 03/03/2019 |