Healthcare Provider Details

I. General information

NPI: 1013088079
Provider Name (Legal Business Name): COUNTY OF LAPEER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 IMLAY CITY RD
LAPEER MI
48446-3208
US

IV. Provider business mailing address

1800 IMLAY CITY RD
LAPEER MI
48446-3208
US

V. Phone/Fax

Practice location:
  • Phone: 810-245-5711
  • Fax: 810-245-4525
Mailing address:
  • Phone: 810-245-5711
  • Fax: 810-245-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number23D0650909
License Number StateMI

VIII. Authorized Official

Name: MS. STEPHANIE SIMMONS
Title or Position: DIRECTOR HEALTH OFFICER
Credential: BSN, MPA
Phone: 810-245-5581