=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356151476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MPOWER PRIMARY CARE PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2025
-----------------------------------------------------
Last Update Date | 07/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4028 STATE ST. SUITE A
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-341-6006
-----------------------------------------------------
Fax | 989-341-3426
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4028 STATE ST. SUITE A
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-341-6006
-----------------------------------------------------
Fax | 989-341-3426
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | TERI LYNN HARRISON
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 989-971-4411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------