is a Nurse Practitioner in Marquette, Michigan. practices all healthcare services and medical treatments related to Nurse Practitioner. The NPI Number for is 1124079710. The last update date is .
's current location address is 49 Smith Ln, Marquette, Michigan. You can contact this provider via phone number 9063615210. The mailing address for is 49 Smith Ln, Marquette, Michigan. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 49 Smith Ln, Marquette, Michigan |
| Phone Number | 9063615210 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1124079710 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 49 Smith Ln |
|---|---|
| City | Marquette |
| State | Michigan (MI) |
| Post Code | 498559352 |
| Phone Number | 9063615210 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Nurse Practitioner |
|---|---|
| Taxonomy | 363L00000X |
| Licence No | 4704222283 |
|
Definition: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certifi |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 5008706020 | MI | BLUE CROSS BLUE SHIELD MI | |
| 104854881 | MI | -- |
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