Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 4704278565 | MI |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704278565 | MI |
NPI | 1083155436 |
---|---|
Provider Name | Vanessa Misukanis |
First Address | Detroit, MI 48202-2608 |
Second Address | Detroit, MI 48202-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2017 |
Last Update Date | 09/05/2017 |