MEDICARE: KAREN LYNN HEMMELSBACH

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	177F00000X	Lodging Provider		MI

General Provider Information

NPI Number	:	1851595821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LYNN HEMMELSBACH

Provider Business Mailing Address
First Line	:	15288 STATE RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9525
Country	:	US
Telephone Number	:	616-846-6153
Fax Number	:	616-846-5101

Provider Business Practice Location Address
First Line	:	15288 STATE RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9525
Country	:	US
Telephone Number	:	616-846-6153
Fax Number	:	616-846-5101

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	07/08/2007

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