Healthcare Provider Details

I. General information

NPI: 1477901759
Provider Name (Legal Business Name): MARIA MCCORMICK DNP, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

150 S CENTER ST
LOWELL MI
49331-1502
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-8220
  • Fax:
Mailing address:
  • Phone: 616-987-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704279863
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: