Healthcare Provider Details

I. General information

NPI: 1649964339
Provider Name (Legal Business Name): NORTHERN MITTEN WOMEN AND CHILDRENS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E MICHIGAN AVE
GRAYLING MI
49738-1749
US

IV. Provider business mailing address

234 E MICHIGAN AVE
GRAYLING MI
49738-1749
US

V. Phone/Fax

Practice location:
  • Phone: 810-429-5150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEWELL BARNARD
Title or Position: RN, BSN, IBCLC
Credential: RN, BSN, IBCLC
Phone: 810-429-5150