Healthcare Provider Details

I. General information

NPI: 1699514166
Provider Name (Legal Business Name): BENJAMIN GOULD FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 US HIGHWAY 23 N
ALPENA MI
49707-1259
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-354-0607
  • Fax: 989-356-6710
Mailing address:
  • Phone: 989-839-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704360094
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: