Healthcare Provider Details

I. General information

NPI: 1588869820
Provider Name (Legal Business Name): MARY ANN DURBIN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 W DEAN RD SUITE C
TEMPERANCE MI
48182-9406
US

IV. Provider business mailing address

1715 W DEAN RD SUITE C
TEMPERANCE MI
48182-9406
US

V. Phone/Fax

Practice location:
  • Phone: 734-847-8100
  • Fax: 734-847-6824
Mailing address:
  • Phone: 734-847-8100
  • Fax: 734-847-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704174668
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: