Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 4704193908 | MI |
NPI | 1053593020 |
---|---|
Provider Name | Renee Marie Worrell |
First Address | Trenton, MI 48183-2114 |
Second Address | Trenton, MI 48183-2114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2007 |
Last Update Date | 14/07/2010 |