Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 6301007406 | MI |
NPI | 1417618372 |
---|---|
Provider Name | Senta Rose |
First Address | Okemos, MI 48864 |
Second Address | Okemos, MI 48864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2022 |
Last Update Date | 04/01/2022 |