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PUNYACHA CHUANCHOM CROCKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1500 EAST MEDICAL CENTER DRIVE, B1 FLOOR TAUBMAN CENTER RECP MOS ROOM 126, ANN ARBOR, MI 48109-5317
(734) 232-2867
Mailing address
3621 SOUTH STATE STREET, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704278307
MI

Other

Enumeration date
12/22/2014
Last updated
11/28/2016
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