Provider Demographics
NPI:1588162200
Name:GEWIRTZ, LINDA KAY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:GEWIRTZ
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:OVID
Mailing Address - State:MI
Mailing Address - Zip Code:48866-9704
Mailing Address - Country:US
Mailing Address - Phone:989-415-9991
Mailing Address - Fax:
Practice Address - Street 1:223 E CLINTON ST
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:MI
Practice Address - Zip Code:48866-9704
Practice Address - Country:US
Practice Address - Phone:989-415-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI10989611163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant