Doctor Name: | MRS. VICKI RUPERT |
NPI Number: | 1336536309 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | WHNP-BC |
License Number: | 4704203400 |
Business Practice Address: | 14651 W Upright St Charlevoix, MI - 497201266 |
Business Phone Number: | 2315474477 |
Business Fax Number: | |
Mailing Address: | 14700 Lake Shore Dr, CHARLEVOIX |
State: | MI |
Postal Code: | 497201931 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/17/2015 |
NPI Last Update Date: | 04/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | 4704203400 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |