=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235018615
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MACEY MARIE ROSS
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2025
-----------------------------------------------------
Last Update Date | 08/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 212 S SULLIVAN AVE
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49412-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-924-6600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9654 ABERDEEN CT
-----------------------------------------------------
City | STANWOOD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49346-9382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-915-2477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------