1568634442 NPI number — GRATIOT-ISABELLA NEPHROLOGY PC

Table of content: TAYLOR ANN DREHER ASW (NPI 1457167900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568634442 NPI number — GRATIOT-ISABELLA NEPHROLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRATIOT-ISABELLA NEPHROLOGY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568634442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 E WARWICK DR
Provider Second Line Business Mailing Address:
SUITE F-2
Provider Business Mailing Address City Name:
ALMA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48801-1083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-463-4805
Provider Business Mailing Address Fax Number:
989-463-4680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 E WARWICK DR
Provider Second Line Business Practice Location Address:
SUITE F-2
Provider Business Practice Location Address City Name:
ALMA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48801-1083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-463-4805
Provider Business Practice Location Address Fax Number:
989-463-4680
Provider Enumeration Date:
03/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FUENTE
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-463-4805

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com