Healthcare Provider Details

I. General information

NPI: 1487204020
Provider Name (Legal Business Name): LAURIE ANN TOWNSLEY AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 ROBERT JONES WAY
KALAMAZOO MI
49009-1904
US

IV. Provider business mailing address

29956 COUNTY ROAD 390
GOBLES MI
49055-9260
US

V. Phone/Fax

Practice location:
  • Phone: 269-552-0420
  • Fax:
Mailing address:
  • Phone: 269-271-1426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704188920
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: