Healthcare Provider Details

I. General information

NPI: 1407591571
Provider Name (Legal Business Name): TERRYCE A BLANCHARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 LEAHY ST STE 201
MUSKEGON MI
49442-5542
US

IV. Provider business mailing address

414 BENSON AVE NE APT 1206
GRAND RAPIDS MI
49503-0009
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-8289
  • Fax:
Mailing address:
  • Phone: 616-405-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101027690
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: