Healthcare Provider Details

I. General information

NPI: 1093144123
Provider Name (Legal Business Name): ANN MARIE NIENHUIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 BEVIER ST
SHELBY MI
49455-1209
US

IV. Provider business mailing address

71 BEVIER ST
SHELBY MI
49455-1209
US

V. Phone/Fax

Practice location:
  • Phone: 231-861-2187
  • Fax: 231-861-5100
Mailing address:
  • Phone: 231-861-2187
  • Fax: 231-861-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704217181
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: