Healthcare Provider Details

I. General information

NPI: 1326469529
Provider Name (Legal Business Name): MS. VALERIE YURGAITES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 FAST ICE DR
MIDLAND MI
48642-6167
US

IV. Provider business mailing address

1323 ELIZABETH ST
MIDLAND MI
48640-4327
US

V. Phone/Fax

Practice location:
  • Phone: 989-631-2320
  • Fax: 989-631-9214
Mailing address:
  • Phone: 989-835-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802066064
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: