MEDICARE: OAKLAND UNIVERSITY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363LP2300X	Primary Care Nurse Practitioner
2	363LW0102X	Women's Health Nurse Practitioner
3	363LA2200X	Adult Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50-0-F3-1791-0	OTHER	MI	BLUE CROSS

General Provider Information

NPI Number	:	1841447117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKLAND UNIVERSITY

Provider Business Mailing Address
First Line	:	2200 N SQUIRREL RD
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48309-4402
Country	:	US
Telephone Number	:	248-370-2341
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 N SQUIRREL RD
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48309-4402
Country	:	US
Telephone Number	:	248-370-2341
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NANCY JANSEN
Credential	:
Telephone Number	:	248-370-2341

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	03/01/2011

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Directions to “OAKLAND UNIVERSITY ” Practice Location

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