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General NPI Number Information
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NPI Number | 1194652206
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Entity Type | Organization
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Legal Business Name | BAY MILLS INDIAN COMMUNITY
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 3095 S TOWEING PINES SUITE 2
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City | BRIMLEY
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State | MI
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Zip | 49715
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Country | US
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Telephone | 906-248-8564
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Fax |
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Provider Business Mailing Address
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Address Line | 12455 W LAKESHORE DR STE 2
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City | BRIMLEY
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State | MI
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Zip | 49715-9327
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Country | US
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Telephone | 906-248-5527
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Fax |
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Authorized Official
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Title or Position | HEALTH DIRECTOR
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Name | LUCY PARISH DEWILDT
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Credential |
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Telephone | 906-248-8372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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