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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