Healthcare Provider Details

I. General information

NPI: 1104901248
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF WEST & NORTHERN MI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E APPLE AVE MUSKEGON PUBLIC HEALTH BUILDING
MUSKEGON MI
49442
US

IV. Provider business mailing address

1205 PECK ST
MUSKEGON MI
49441-2121
US

V. Phone/Fax

Practice location:
  • Phone: 231-724-4415
  • Fax:
Mailing address:
  • Phone: 231-722-2928
  • Fax: 231-722-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: DIANE BRADY
Title or Position: COO
Credential:
Phone: 616-774-7005