1407096316 NPI number — WONDERFULLY MADE WOMEN'S HEALTH CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407096316 NPI number — WONDERFULLY MADE WOMEN'S HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WONDERFULLY MADE WOMEN'S HEALTH CARE
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:
1407096316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24622 ADAMS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48335-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 W TROY ST
Provider Second Line Business Practice Location Address:
SUITE 3030
Provider Business Practice Location Address City Name:
FERNDALE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48220-1892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-259-4947
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
CHARLENE
Authorized Official Middle Name:
VEE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
248-259-4947

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  4301082260 , 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)





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