Organization
GRAND LAKE HEALTH CENTER LLC
Active
Other names
Journey Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COREEN JEAN WILLIAMS FNP (EXECUTIVE DIRECTOR/OWNER)
(989) 354-0860
Entity
Organization
Contact information
Practice address
1691 M 32 W, SUITE 300, ALPENA, MI 49707-8210
(989) 354-0860
(989) 354-0880
Mailing address
1691 M 32 W, SUITE 300, ALPENA, MI 49707-8210
(989) 354-0860
(989) 354-0880
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704151039
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0870556
BCBSM
MI
01
—
11905624
CAQH
MI
05
—
4485877
—
MI
01
—
500027624
RAILROAD MEDICARE
MI
01
—
7000525321
PRIORITY HEALTH
MI
Enumeration date
02/24/2013
Last updated
06/17/2013
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