Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 4704147038 | MI |
NPI | 1265513980 |
---|---|
Provider Name | Sandra Jean Cagle |
First Address | West Bloomfield, MI 48322-3512 |
Second Address | Madison Heights, MI 48071-3487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 04/03/2020 |