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General NPI Number Information
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NPI Number | 1255664470
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Entity Type | Organization
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Legal Business Name | GERBER MEMORIAL HEALTH SERVICE
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 230 S MAPLE ST
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City | GRANT
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State | MI
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Zip | 49327-9006
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Country | US
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Telephone | 231-834-5995
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Fax | 231-834-0248
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Provider Business Mailing Address
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Address Line | 230 S MAPLE ST
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City | GRANT
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State | MI
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Zip | 49327-9006
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Country | US
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Telephone | 231-834-5995
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Fax | 231-834-0248
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Authorized Official
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Title or Position | DIRECTOER
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Name | MS. DIANNA L BROWN
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Credential | FNP
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Telephone | 231-854-6415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 43028094
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License Number State | MI
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