| NPI | 1003209255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIEDRE WELLER Director Finance 231-924-1380 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LX0001X Nurse Practitioner, Obstetrics & Gynecology | |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2015-03-12 |