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General NPI Number Information
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NPI Number | 1104625706
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Entity Type | Organization
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Legal Business Name | ONLINE OBGYN, PLLC
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 113 W SAVIDGE ST
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City | SPRING LAKE
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State | MI
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Zip | 49456-1715
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Country | US
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Telephone | 517-980-4752
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Fax |
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Provider Business Mailing Address
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Address Line | 840 JACKSON AVE STE 1058
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City | GRAND HAVEN
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State | MI
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Zip | 49417-1179
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIANA EILEEN OKUNIEWSKI
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Credential | DO
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Telephone | 517-980-4752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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