Provider Demographics
NPI:1063767655
Name:WOMEN'S INTEGRATED HEALTH CARE
Entity type:Organization
Organization Name:WOMEN'S INTEGRATED HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUSHLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-606-7739
Mailing Address - Street 1:10004 E LIPPINCOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-9013
Mailing Address - Country:US
Mailing Address - Phone:810-653-0388
Mailing Address - Fax:810-653-0929
Practice Address - Street 1:1595 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8068
Practice Address - Country:US
Practice Address - Phone:810-606-7739
Practice Address - Fax:810-606-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704155625363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M91400Medicare UPIN