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General NPI Number Information
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NPI Number | 1558457663
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Entity Type | Organization
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Legal Business Name | NORTHWOODS HOLISTIC HEALTH CENTER, PLC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1021 W BARAGA AVE STE B
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City | MARQUETTE
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State | MI
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Zip | 49855-4030
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Country | US
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Telephone | 906-226-6790
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Fax | 906-226-6803
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Provider Business Mailing Address
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Address Line | 1021 W BARAGA AVE STE B
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City | MARQUETTE
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State | MI
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Zip | 49855-4030
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Country | US
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Telephone | 906-226-6790
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Fax | 906-226-6803
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | DR. SANDRA K MCCOWEN
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Credential | M.D.
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Telephone | 906-226-6790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | D05942
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License Number State | MI
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