Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704336065 | MI |
NPI | 1003323775 |
---|---|
Provider Name | Stacy Lamontagna |
First Address | Sault Sainte Marie, MI 49783-3740 |
Second Address | Sault Sainte Marie, MI 49783-3740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2018 |
Last Update Date | 04/01/2018 |