Individual
PENNY MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
5301 E HURON RIVER DR, YPSILANTI, MI 48197-1051
(734) 712-8676
(734) 712-3855
Mailing address
24 FRANK LLOYD WRIGHT DR, PO BOX 0446 - LOBBY J, ANN ARBOR, MI 48105-9484
(734) 747-6766
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704180055
MI
Other
Enumeration date
12/01/2016
Last updated
12/01/2016
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