| NPI | 1174166052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTY ELLER Credentailing Coordinator 231-727-5211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2019-10-23 |