Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901021728 | MI |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS038591 | PA |
NPI | 1093913626 |
---|---|
Provider Name | Roseanna P Noordhoek |
First Address | Hartland, MI 48353-2726 |
Second Address | Hartland, MI 48353-2726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 14/03/2016 |