Organization
MCLAREN BAY REGION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE C JACKS PORTER (CFO)
(989) 894-3838
Entity
Organization
Contact information
Practice address
1360 N SAINT HELEN RD, SAINT HELEN, MI 48656
(989) 329-4944
(989) 389-1401
Mailing address
1360 N SAINT HELEN RD, PO BOX 39, SAINT HELEN, MI 48656-9521
(989) 329-4944
(989) 389-1401
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
08/15/2011
Last updated
08/07/2018
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