Healthcare Provider Details

I. General information

NPI: 1548934623
Provider Name (Legal Business Name): INDEPENDENT CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10146 ABERDEEN DR
GRAND BLANC MI
48439-9574
US

IV. Provider business mailing address

PO BOX 1373
CLARKSTON MI
48347-1373
US

V. Phone/Fax

Practice location:
  • Phone: 810-869-5051
  • Fax: 855-824-2920
Mailing address:
  • Phone: 810-869-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMI PARKER GLASCO
Title or Position: CEO CASE MANAGER / ADMINISTRATOR
Credential: RNBSN CCM
Phone: 810-869-5051