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General NPI Number Information
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NPI Number | 1558070763
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Entity Type | Organization
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Legal Business Name | EA MEDICAL, PLLC
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Dates
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Enumeration Date | 11/16/2022
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 232 W MAIN ST
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City | GAYLORD
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State | MI
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Zip | 49735-1347
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Country | US
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Telephone | 989-787-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 135 GOSLOW RD
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City | GAYLORD
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State | MI
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Zip | 49735-9700
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Country | US
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Telephone | 989-787-0022
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. EMILYJO RENA COURTERIER
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Credential | FNP-C
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Telephone | 989-787-0022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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