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Organization
GRAND TRAVERSE WOMENS CLINIC
Active
Organization
GRAND TRAVERSE WOMENS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BARBARA ROGERS (CREDENTIALING SPECIALIST)
(231) 392-0655
Entity
Organization
Contact information
Practice address
1200 SIXTH ST, STE 400, TRAVERSE CITY, MI 49684-2369
(231) 392-0655
(231) 392-0691
Mailing address
1200 SIXTH ST, STE 400, TRAVERSE CITY, MI 49684-2369
(231) 392-0655
(231) 392-0691
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
4704273686
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704273686
LICENSE
MI
Enumeration date
10/05/2012
Last updated
02/24/2016
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