Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704264499 | MI |
NPI | 1073850376 |
---|---|
Provider Name | Veronica Mae Riess |
First Address | Mount Pleasant, MI 48858-9510 |
Second Address | Mount Pleasant, MI 48858-8931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2013 |
Last Update Date | 02/04/2013 |