Individual
MARY FILLMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
13949 ROBINHOOD LN, LEROY, MI 49655-9386
(906) 322-0091
Mailing address
13949 ROBINHOOD LN, LEROY, MI 49655-9386
(906) 322-0091
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704284792
MI
Other
Enumeration date
09/30/2024
Last updated
10/01/2024
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