=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972732402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARTNERS IN HEALTH AT QUINCY INTERMED LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2009
-----------------------------------------------------
Last Update Date | 07/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 E CHICAGO ST
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49082-1165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-639-5354
-----------------------------------------------------
Fax | 517-639-5344
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 E CHICAGO ST
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49082-1165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-639-5354
-----------------------------------------------------
Fax | 517-639-5344
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHELLE R MILLER
-----------------------------------------------------
Credential | APRN-BC
-----------------------------------------------------
Telephone | 517-639-5354
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------