Healthcare Provider Details

I. General information

NPI: 1932349396
Provider Name (Legal Business Name): ST CLAIR COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 28TH ST
PORT HURON MI
48060-6931
US

IV. Provider business mailing address

3415 28TH ST
PORT HURON MI
48060-6931
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-9396
  • Fax: 810-985-2150
Mailing address:
  • Phone: 810-987-9396
  • Fax: 810-985-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTP173662
License Number StateMI

VIII. Authorized Official

Name: MR. JON B PARSON
Title or Position: DIRECTOR, HEALTH OFFICER
Credential: M.P.H.
Phone: 810-987-9396