Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 4704324071 | MI |
NPI | 1144992629 |
---|---|
Provider Name | Sevan Markosian |
First Address | Farmington Hills, MI 48331-1115 |
Second Address | Detroit, MI 48236-2148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2021 |
Last Update Date | 02/10/2021 |