Healthcare Provider Details

I. General information

NPI: 1972507739
Provider Name (Legal Business Name): ELAINE M RAWSKY GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 E GRAND RIVER AVE STE 204
HOWELL MI
48843-7555
US

IV. Provider business mailing address

3399 E GRAND RIVER AVE STE 204
HOWELL MI
48843-7555
US

V. Phone/Fax

Practice location:
  • Phone: 517-540-0709
  • Fax: 517-540-1775
Mailing address:
  • Phone: 517-540-0709
  • Fax: 517-540-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number4704147728
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704147728
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: