Healthcare Provider Details

I. General information

NPI: 1588162200
Provider Name (Legal Business Name): LINDA KAY GEWIRTZ RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 01/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E CLINTON ST
OVID MI
48866-9704
US

IV. Provider business mailing address

223 E CLINTON ST
OVID MI
48866-9704
US

V. Phone/Fax

Practice location:
  • Phone: 989-415-9991
  • Fax:
Mailing address:
  • Phone: 989-415-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number10989611
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: