| Organization Name: | ST. MARY'S OF MICHIGAN |
| NPI Number: | 1669548061 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LYNNE WALE (MANAGER PHYSICIAN SERVICES) |
| Mailing Address: | 1212 W Saginaw Rd Vassar |
| State: | MI US |
| Postal Code: | 487689483 |
| Phone Number: | 9898235020 |
| Fax Number: | 9898237881 |
| NPI Enumeration Date: | 11/28/2006 |
| NPI Last Update Date: | 01/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704173083 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |