Healthcare Provider Details

I. General information

NPI: 1942285317
Provider Name (Legal Business Name): EVA M. FRONK MSN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 GULL RD
KALAMAZOO MI
49048-1650
US

IV. Provider business mailing address

1304 CATSYL RD
JACKSON MI
49203-5995
US

V. Phone/Fax

Practice location:
  • Phone: 269-226-5927
  • Fax:
Mailing address:
  • Phone: 828-434-5073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN129848
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number296
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704189472
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: