Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2301010506 | MI |
NPI | 1942746979 |
---|---|
Provider Name | Rachel Sullivant |
First Address | Grand Blanc, MI 48439-8623 |
Second Address | Flint, MI 48507-2677 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2017 |
Last Update Date | 14/01/2017 |