MEDICARE: MS. MARY JO ANN DOERR RNC, MSN, WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	4704152127	MI

General Provider Information

NPI Number	:	1780892711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY JO ANN DOERR RNC, MSN, WHNP

Provider Business Mailing Address
First Line	:	11487 N SIX LAKES RD
Second Line	:
City	:	SIX LAKES
State	:	MI
Zip	:	48886
Country	:	US
Telephone Number	:	989-365-3637
Fax Number	:

Provider Business Practice Location Address
First Line	:	11487 N SIX LAKES RD
Second Line	:
City	:	SIX LAKES
State	:	MI
Zip	:	48886
Country	:	US
Telephone Number	:	989-365-3637
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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