Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | MI |
NPI | 1265197859 |
---|---|
Provider Name | Savanna Rose Darga |
First Address | Flint, MI 48532-3440 |
Second Address | Flint, MI 48532-3440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2021 |
Last Update Date | 12/11/2021 |