Healthcare Provider Details

I. General information

NPI: 1497858609
Provider Name (Legal Business Name): SUZANNE RINEHART CHRISCO-WILCOX CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 M-139
BENTON HARBOR MI
49022-4843
US

IV. Provider business mailing address

129 E MAIN ST
BENTON HARBOR MI
49022-4409
US

V. Phone/Fax

Practice location:
  • Phone: 269-927-5400
  • Fax: 269-927-5493
Mailing address:
  • Phone: 269-985-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704215737
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: