Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704273449 | MI |
NPI | 1073270609 |
---|---|
Provider Name | Nicorya Scott |
First Address | Detroit, MI 48203-1419 |
Second Address | Detroit, MI 48202-3450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2021 |
Last Update Date | 18/11/2021 |