Basic Information
| Provider Information | |||||||||
| NPI: | 1659741908 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MUNSON MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2009 BLACK FOREST LN | ||||||||
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| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496968169 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1105 SIXTH ST | ||||||||
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| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496842349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319355000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 09/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | COMFORT | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER/ONCOLOGY | ||||||||
| AuthorizedOfficialTelephone: | 2318832320 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704275908 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.