Healthcare Provider Details

I. General information

NPI: 1912443441
Provider Name (Legal Business Name): HEATHER RATLIFF R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2017
Last Update Date: 01/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8191 MOORSBRIDGE RD
PORTAGE MI
49024-7416
US

IV. Provider business mailing address

916 SUNSET LN
KALAMAZOO MI
49008-2312
US

V. Phone/Fax

Practice location:
  • Phone: 269-312-8170
  • Fax:
Mailing address:
  • Phone: 269-303-0847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704289678
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: