Healthcare Provider Details

I. General information

NPI: 1194652206
Provider Name (Legal Business Name): BAY MILLS INDIAN COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 S TOWEING PINES SUITE 2
BRIMLEY MI
49715
US

IV. Provider business mailing address

12455 W LAKESHORE DR STE 2
BRIMLEY MI
49715-9327
US

V. Phone/Fax

Practice location:
  • Phone: 906-248-8564
  • Fax:
Mailing address:
  • Phone: 906-248-5527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LUCY PARISH DEWILDT
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 906-248-8372