Healthcare Provider Details

I. General information

NPI: 1174432264
Provider Name (Legal Business Name): EMILY GRACE RUMSTADT RN, NP STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S LINDEN RD
FLINT MI
48532-9800
US

IV. Provider business mailing address

4169 GREEN MEADOWS BLVD APT 112
YPSILANTI MI
48197-7261
US

V. Phone/Fax

Practice location:
  • Phone: 248-325-4734
  • Fax:
Mailing address:
  • Phone: 248-325-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number4704414177
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: