Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704145582 | MI |
NPI | 1033277132 |
---|---|
Provider Name | Sandra Oliver-Mcneil |
First Address | West Bloomfield, MI 48322-4457 |
Second Address | West Bloomfield, MI 48322-4457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5008665880 | (02) | MI |