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Organization
MAIN STREET FAMILY PRACTICE PC
Active
Organization
MAIN STREET FAMILY PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARILYN ELIZABETH LOUIS CFNP (ONWER)
(989) 343-1367
Entity
Organization
Contact information
Practice address
117 S BURGESS ST, WEST BRANCH, MI 48661-1403
(989) 343-1367
(989) 343-1427
Mailing address
117 S BURGESS ST, WEST BRANCH, MI 48661-1403
(989) 343-1367
(989) 343-1427
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4627355
—
MI
01
—
5008703250
BCBSM
MI
Enumeration date
06/08/2007
Last updated
08/27/2009
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