Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | MI |
NPI | 1184070211 |
---|---|
Provider Name | Tomeca Shamly |
First Address | Flint, MI 48503-3975 |
Second Address | Flint, MI 48503-3975 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2016 |
Last Update Date | 07/05/2016 |