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General NPI Number Information
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NPI Number | 1629697008
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Entity Type | Organization
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Legal Business Name | HOMETOWN PROVIDER LLC
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 9112 N LINDEN RD
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City | CLIO
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State | MI
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Zip | 48420-8524
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Country | US
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Telephone | 810-610-7125
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Fax |
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Provider Business Mailing Address
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Address Line | 9112 N LINDEN RD
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City | CLIO
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State | MI
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Zip | 48420-8524
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Country | US
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Telephone | 810-610-7125
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | REBECCA LYNN AARON
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Credential | NP
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Telephone | 810-610-7125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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