Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1053839910 |
---|---|
Provider Name | Rebekah Plantz |
First Address | Mount Morris, MI 48458-8807 |
Second Address | Flint, MI 48503-2190 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2017 |
Last Update Date | 31/08/2017 |