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General NPI Number Information
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NPI Number | 1427514306
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Entity Type | Organization
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Legal Business Name | ELDER CARE OF WEST MICHIGAN PLLC
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Dates
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Enumeration Date | 02/15/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 6785 MYERS LAKE AVE NE
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City | ROCKFORD
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State | MI
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Zip | 49341-7416
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Country | US
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Telephone | 616-366-4234
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Fax | 616-469-1118
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Provider Business Mailing Address
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Address Line | 4448 KOINONIA DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9332
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | KATHY JO UECKER
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Credential |
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Telephone | 269-420-9404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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