Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 4704076259 | MI |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 4704076259 | MI |
NPI | 1114929338 |
---|---|
Provider Name | Sally Rae Arbuckle |
First Address | Southfield, MI 48075-4818 |
Second Address | Southfield, MI 48075-4818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 18/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
439455810 | (05) | MI |