Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704262903 | MI |
NPI | 1003150574 |
---|---|
Provider Name | Nina K Bibicoff |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2012 |
Last Update Date | 21/11/2012 |