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General NPI Number Information
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NPI Number | 1215823323
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Entity Type | Organization
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Legal Business Name | -
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 2120 GRAND RIVER ANX STE 700
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City | BRIGHTON
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State | MI
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Zip | 48114-7391
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Country | US
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Telephone | 810-206-1776
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 GRAND RIVER ANX STE 700
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City | BRIGHTON
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State | MI
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Zip | 48114-7391
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Country | US
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Telephone | 810-206-1776
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CATHERINE BURTRUM
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Credential | DO
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Telephone | 517-748-7399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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