Individual
MISS PRIMA MARDHATILLAH MUZIRMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1780 E PARNALL RD, JACKSON, MI 49201-7136
(517) 780-6004
Mailing address
6346 BEECHFIELD DR, LANSING, MI 48911-5735
(517) 410-1388
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704248754
MI
Other
Enumeration date
09/19/2014
Last updated
09/19/2014
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