# GRAND TRAVERSE WOMENS CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942552559
- **Authorized official:** MS. BARBARA ROGERS (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (231) 392-0655

## Contact information

- **Practice address:** 1200 SIXTH ST, STE 400, TRAVERSE CITY, MI 49684-2369
- **Practice address phone:** (231) 392-0655
- **Practice address fax:** (231) 392-0691
- **Mailing address:** 1200 SIXTH ST, STE 400, TRAVERSE CITY, MI 49684-2369
- **Mailing address phone:** (231) 392-0655
- **Mailing address fax:** (231) 392-0691

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | 4704273686 | MI | Yes |

## Other

- **Enumeration date:** 10/05/2012
- **Last updated:** 02/24/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4704273686 | LICENSE | MI |