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General NPI Number Information
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NPI Number | 1538492095
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Entity Type | Individual
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Provider Name | GRACE OGLE MISHKIN CFNP, CNM
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Gender | Female
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 5333 MCAULEY DR RM 2110
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City | YPSILANTI
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State | MI
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Zip | 48197-1097
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Country | US
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Telephone | 734-712-3967
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Fax | 734-712-2341
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR STE J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105-9484
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Country | US
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Telephone | 734-747-6766
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Fax | 734-222-3100
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | C-APN.0001084-C-CNM
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 4704252910
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | C-APN.0000906-C-NP
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704252910
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License Number State | MI
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