Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704231812 | MI |
NPI | 1003184268 |
---|---|
Provider Name | Robin Wawersik |
First Address | Dearborn, MI 48124 |
Second Address | Dearborn, MI 48124-5031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2011 |
Last Update Date | 02/12/2011 |