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General NPI Number Information
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NPI Number | 1548497399
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Entity Type | Organization
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Legal Business Name | ST. MARY'S OF MICHIGAN
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 805 WEST CEDAR
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City | STANDISH
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State | MI
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Zip | 48658
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Country | US
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Telephone | 989-846-3407
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Fax |
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Provider Business Mailing Address
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Address Line | 805 W CEDAR ST
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City | STANDISH
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State | MI
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Zip | 48658-9526
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Country | US
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Telephone | 989-846-3407
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | KRYSTAL THELEN
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Credential | MS, RD
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Telephone | 989-846-3407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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