MEDICARE: ELAINE M RAWSKY GNP

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	163WG0100X	Gastroenterology Registered Nurse		MI
2	163WG0100X	Gastroenterology Registered Nurse	4704147728	MI
3	363L00000X	Nurse Practitioner	4704147728	MI

General Provider Information

NPI Number	:	1972507739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE M RAWSKY GNP

Provider Business Mailing Address
First Line	:	3399 E GRAND RIVER AVE
Second Line	:	STE 204
City	:	HOWELL
State	:	MI
Zip	:	48843-7555
Country	:	US
Telephone Number	:	517-540-0709
Fax Number	:	517-540-1775

Provider Business Practice Location Address
First Line	:	3399 E GRAND RIVER AVE
Second Line	:	STE 204
City	:	HOWELL
State	:	MI
Zip	:	48843-7555
Country	:	US
Telephone Number	:	517-540-0709
Fax Number	:	517-540-1775

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/21/2022

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