Healthcare Provider Details

I. General information

NPI: 1780186254
Provider Name (Legal Business Name): CONNIE TERRI HUHN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E WASHINGTON ST
IONIA MI
48846-2202
US

IV. Provider business mailing address

550 E WASHINGTON ST
IONIA MI
48846-2202
US

V. Phone/Fax

Practice location:
  • Phone: 616-523-1644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704272471
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704272471
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: