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General NPI Number Information
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NPI Number | 1669712907
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Entity Type | Organization
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Legal Business Name | GRAND LAKE HEALTH CENTER LLC
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Dates
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Enumeration Date | 02/24/2013
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 1691 M 32 W SUITE 300
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City | ALPENA
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State | MI
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Zip | 49707-8210
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Country | US
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Telephone | 989-354-0860
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Fax | 989-354-0880
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Provider Business Mailing Address
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Address Line | 1691 M 32 W SUITE 300
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City | ALPENA
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State | MI
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Zip | 49707-8210
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Country | US
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Telephone | 989-354-0860
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Fax | 989-354-0880
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/OWNER
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Name | DR. COREEN JEAN WILLIAMS
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Credential | FNP
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Telephone | 989-354-0860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704151039
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License Number State | MI
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