Healthcare Provider Details

I. General information

NPI: 1063767655
Provider Name (Legal Business Name): WOMEN'S INTEGRATED HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 GENESYS PKWY
GRAND BLANC MI
48439-8068
US

IV. Provider business mailing address

10004 E LIPPINCOTT BLVD
DAVISON MI
48423-9013
US

V. Phone/Fax

Practice location:
  • Phone: 810-606-7739
  • Fax: 810-606-9400
Mailing address:
  • Phone: 810-653-0388
  • Fax: 810-653-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number4704155625
License Number StateMI

VIII. Authorized Official

Name: DIANA L RUSHLOW
Title or Position: PRACTICE MANAGER
Credential:
Phone: 810-606-7739