Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1114302957 |
---|---|
Provider Name | Thea Nashira Hogue |
First Address | Westland, MI 48185-7249 |
Second Address | Westland, MI 48185-7249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2015 |
Last Update Date | 22/07/2015 |