Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1235778663 |
---|---|
Provider Name | Samantha Mints |
First Address | Ann Arbor, MI 48104-6830 |
Second Address | Livonia, MI 48154-5403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2020 |
Last Update Date | 02/01/2020 |