Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4704207173 | MI |
NPI | 1053874248 |
---|---|
Provider Name | Suzanne Kathleen Dubuque |
First Address | Howell, MI 48855-9764 |
Second Address | Brighton, MI 48114-9349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2019 |
Last Update Date | 13/04/2019 |