Basic Information
Provider Information
NPI: 1003804881
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FIFE
FirstName: ROSE
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 501 LAPEER
Address2: HEALTH DELIVERY INC
City: SAGINAW
State: MI
PostalCode: 486071208
CountryCode: US
TelephoneNumber: 9897596464
FaxNumber: 9893998233
Practice Location
Address1: 3175 W PROFESSIONAL DR
Address2:  
City: BAY CITY
State: MI
PostalCode: 48706
CountryCode: US
TelephoneNumber: 9896673377
FaxNumber: 9896679991
Other Information
ProviderEnumerationDate: 10/06/2005
LastUpdateDate: 03/09/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X4704113509MIY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

ID Information
IDTypeStateIssuerDescription
21001 COMMUNITY CHOICE OF MIOTHER
42000132401 RAILROAD MEDICAREOTHER
420G31080001 BCBS OF MICHIGANOTHER
100913401 HEALTH ADVANTAGE PPOOTHER
3778301MIHEALTH PLAN OF MICHIGANOTHER
38190832801 UNITED HEALTH CAREOTHER
452989101 MOLINA HEALTH CARE OF MIOTHER
733025901 AETNAOTHER
099566801 HEALTHPLUS OF MICHIGANOTHER
100380488105MI MEDICAID
11869101 GREAT LAKES HEALTH PLANOTHER
936663701 CIGNA PHCSOTHER
100913401 MCLAREN HEALTH PLANOTHER


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