Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LG0600X | Nurse Practitioner - Gerontology | 4704201024 | MI |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704201024 | MI |
NPI | 1083108831 |
---|---|
Provider Name | Suzanne J Miron |
First Address | Gwinn, MI 49841-2813 |
Second Address | Ontonagon, MI 49953 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2018 |
Last Update Date | 14/04/2021 |