Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F12180521 | MI |
NPI | 1063986479 |
---|---|
Provider Name | Rosario Tanguay |
First Address | Jackson, MI 49203-3646 |
Second Address | Saint Johns, MI 48879-9200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2019 |
Last Update Date | 18/01/2019 |