MEDICARE: MARLENE MICHALOWSKI O.G.N.P.

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	363LW0102X	Women's Health Nurse Practitioner	4704080623	MI

General Provider Information

NPI Number	:	1780680306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENE MICHALOWSKI O.G.N.P.

Provider Business Mailing Address
First Line	:	2548 PINE OAK COURT
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 S MISSION ST
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-4207
Country	:	US
Telephone Number	:	989-773-5602
Fax Number	:	989-775-3305

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/08/2007

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