Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | MI |
NPI | 1093472250 |
---|---|
Provider Name | Rebecca Gail Nyhof |
First Address | Flint, MI 48504-4255 |
Second Address | Flint, MI 48504-4255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2021 |
Last Update Date | 23/11/2021 |