Provider Demographics
NPI:1942641089
Name:NERENBERG, LAURA MICHELLE SUPKOFF
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE SUPKOFF
Last Name:NERENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MICHELLE
Other - Last Name:SUPKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 E WASHINGTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2057
Mailing Address - Country:US
Mailing Address - Phone:743-763-3471
Mailing Address - Fax:
Practice Address - Street 1:500 E WASHINGTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2057
Practice Address - Country:US
Practice Address - Phone:743-763-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program