Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN.CNP.0027398 | OH |
NPI | 1003421827 |
---|---|
Provider Name | Rachel Bird |
First Address | Detroit, MI 48267-5103 |
Second Address | Beavercreek, OH 45324-6502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2020 |
Last Update Date | 09/09/2020 |