=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174389605
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUELINE HEALTH CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2024
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2040 RAYBROOK ST SE STE 200
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-7718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-386-4260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6757 CASCADE RD SE PMB 89
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-6849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-648-0095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ADMINISTRATOR
-----------------------------------------------------
Name | NANCY TUOHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 616-648-0095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------