| Doctor Name: | MARY POMERVILLE |
| NPI Number: | 1013017516 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | 4704129818 |
| Business Practice Address: | 301 W Franklin St Clinton, MI - 492369744 |
| Business Phone Number: | 5174567449 |
| Business Fax Number: | 5174566059 |
| Mailing Address: | 2100 Commonwealth Blvd, Suite 202 ANN ARBOR |
| State: | MI |
| Postal Code: | 481051593 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/24/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704129818 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |