Healthcare Provider Details

I. General information

NPI: 1033129549
Provider Name (Legal Business Name): ALISA RUMMEL WOLNER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 REGENCY PARK DR STE A
GRAND BLANC MI
48439-2567
US

IV. Provider business mailing address

3434 REGENCY PARK DR STE A
GRAND BLANC MI
48439-2567
US

V. Phone/Fax

Practice location:
  • Phone: 810-694-9400
  • Fax: 810-694-9445
Mailing address:
  • Phone: 810-694-9400
  • Fax: 810-694-9445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5315215959
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: