1437332871 NPI number — DR. JEANETTE MCDOWELL FORREST LLP

Table of content: DR. JEANETTE MCDOWELL FORREST LLP (NPI 1437332871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437332871 NPI number — DR. JEANETTE MCDOWELL FORREST LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDOWELL FORREST
Provider First Name:
JEANETTE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCDOWELL
Provider Other First Name:
GERTRUDE
Provider Other Middle Name:
JEANETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437332871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 E FULTON ST
Provider Second Line Business Mailing Address:
SUITE 114-C
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49503-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-776-3923
Provider Business Mailing Address Fax Number:
616-776-3024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
233 FULTON ST E STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-3261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-776-3923
Provider Business Practice Location Address Fax Number:
616-776-3024
Provider Enumeration Date:
12/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  6301009848 , 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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