Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 4704132097 | MI |
NPI | 1043310618 |
---|---|
Provider Name | Patricia Reckling |
First Address | Ann Arbor, MI 48105-9484 |
Second Address | Canton, MI 48187-4849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 27/10/2011 |