Individual
MRS. SALLY ANN MUDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1200 N TELEGRAPH RD BLDG 32E, PONTIAC, MI 48341-1032
(248) 541-3522
Mailing address
1200 N TELEGRAPH RD BLDG 32E, PONTIAC, MI 48341-1032
(248) 541-3522
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704084549
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9140860054
AETNA
MI
Enumeration date
11/18/2016
Last updated
11/18/2016
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