Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 4704254570 | MI |
NPI | 1316440860 |
---|---|
Provider Name | Renee Marie Vigilante |
First Address | Canton, MI 48187-2976 |
Second Address | Detroit, MI 48201-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2018 |
Last Update Date | 12/03/2018 |