Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 4301076137 | MI |
NPI | 1063428860 |
---|---|
Provider Name | Robin Pierucci |
First Address | Kalamazoo, MI 49007-5341 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4677160 | (05) | MI |
H11360 | (02) | MI |