Healthcare Provider Details

I. General information

NPI: 1386700318
Provider Name (Legal Business Name): SHARON RUBICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 LAKE AVE #21
NORTH MUSKEGON MI
49445
US

IV. Provider business mailing address

2411 LAKE AVE #21
NORTH MUSKEGON MI
49445
US

V. Phone/Fax

Practice location:
  • Phone: 616-813-2679
  • Fax: 231-719-2809
Mailing address:
  • Phone: 616-813-2679
  • Fax: 231-719-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4704088816 1878905
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number4704088816 1879905
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number4704088816RN
License Number StateMI

VIII. Authorized Official

Name: MRS. SHARON ANN RUBICK
Title or Position: OWNER PRESIDENT
Credential: RN
Phone: 616-813-2679