Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704217211 | MI |
NPI | 1083167100 |
---|---|
Provider Name | Talona Sue Carpenter-Schultz |
First Address | Ceresco, MI 49033-9697 |
Second Address | Springfield, MI 49037-7685 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2016 |
Last Update Date | 12/01/2017 |