MEDICARE: STARRY NIGHT ART AND NATURE CONSERVATORY

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1326385915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARRY NIGHT ART AND NATURE CONSERVATORY

Provider Business Mailing Address
First Line	:	1023 PARKVIEW DR
Second Line	:
City	:	LAKE ISABELLA
State	:	MI
Zip	:	48893-9349
Country	:	US
Telephone Number	:	989-621-6841
Fax Number	:	989-772-2833

Provider Business Practice Location Address
First Line	:	1023 PARKVIEW DR
Second Line	:
City	:	LAKE ISABELLA
State	:	MI
Zip	:	48893-9349
Country	:	US
Telephone Number	:	989-621-6841
Fax Number	:	989-772-2833

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARIE LOUISE LANNEN
Credential	:	M.A.
Telephone Number	:	989-772-2833

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	06/24/2013

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