Individual
MRS. CHARITY KATIO OTIENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3333 SPRING ARBOR RD, JACKSON, MI 49203-8605
(517) 205-1000
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4204267626
MI
363LA2200X
Adult Health Nurse Practitioner
AG07190244
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704267626
MI
Other
Enumeration date
04/23/2019
Last updated
01/30/2023
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