Individual
GAIL CHRISTINE PROVENCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN (EMERITUS), RN,
Contact information
Practice address
12539 RETREAT DR, GRAND HAVEN, MI 49417-7672
(706) 466-4639
Mailing address
12539 RETREAT DR, GRAND HAVEN, MI 49417-7672
(706) 466-4639
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
4704309077
MI
Other
Enumeration date
05/14/2008
Last updated
01/09/2016
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