MEDICARE: MRS. CATHLEEN MARGARET MCCARTNEY RANCOURT R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0200X	Pediatric Registered Nurse	4704176205	MI

General Provider Information

NPI Number	:	1053584466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHLEEN MARGARET MCCARTNEY RANCOURT R.N.

Provider Business Mailing Address
First Line	:	7381 OLD LANTERN DR SE
Second Line	:
City	:	CALEDONIA
State	:	MI
Zip	:	49316-9004
Country	:	US
Telephone Number	:	616-554-2088
Fax Number	:	616-554-2377

Provider Business Practice Location Address
First Line	:	2703 DEAN LAKE AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-3958
Country	:	US
Telephone Number	:	616-365-9160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2008
Last Update Date	:	04/07/2008

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