Healthcare Provider Details

I. General information

NPI: 1659949998
Provider Name (Legal Business Name): BETSY FUZI CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 HOLLYWOOD RD STE 100
SAINT JOSEPH MI
49085-9151
US

IV. Provider business mailing address

3950 HOLLYWOOD RD STE 100
SAINT JOSEPH MI
49085-9151
US

V. Phone/Fax

Practice location:
  • Phone: 269-429-8010
  • Fax:
Mailing address:
  • Phone: 269-429-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704220395
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: