Individual
PORSCHE UFOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
36669 AUDREY RD, NEW BALTIMORE, MI 48047-5565
(586) 569-1039
Mailing address
36669 AUDREY RD, NEW BALTIMORE, MI 48047-5565
(586) 569-1039
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704305221
MI
Other
Enumeration date
10/17/2023
Last updated
10/17/2023
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