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Great Lakes Plastic Surgery Center
Nurse Practitioner in Traverse City, Michigan
NPI 1972795334

Great Lakes Plastic Surgery Center is a Nurse Practitioner based in Traverse City, MI. Great Lakes Plastic Surgery Center practices in Traverse City, MI. The NPI Number for Great Lakes Plastic Surgery Center is 1972795334 and holds a License No. (Michigan).

The current practice location address for Great Lakes Plastic Surgery Center is 5085 Anna Dr, Traverse City, MI and can be reached out via phone at 231-935-0180 and via fax at 231-935-0099.

Location: 5085 Anna Dr, Traverse City, MI, 49684-9691
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1972795334
Provider Name
Great Lakes Plastic Surgery Center
Credential
Provider Entity Type
Organization
Address
5085 Anna Dr, Traverse City, MI, 49684-9691
Phone Number
231-935-0180
Fax Number
231-935-0099
Provider Enumeration Date
08/09/2007
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
4301067433 01 MI STATE LICENSE
2402810821 01 MI BLUE CROSS BLUE SHIELD MI
1285614032 01 MI NPI
4156180 05 MI
4704192319 01 MI STATE LICENSE
1437139318 01 MI NPI
3495242 05 MI
5008762590 01 MI BLUE CROSS BLUE SHIELD MI
institution
Provider Business Practice Location Address Details
Address
5085 Anna Dr
City
Traverse City
State
Michigan
Zip
49684-9691
Phone Number
231-935-0180
Fax Number
231-935-0099
person
Provider Business Mailing Address Details
Address
5085 Anna Dr
City
Traverse City
State
Michigan
Zip
49684-9691
Phone Number
231-935-0180
Fax Number
231-935-0099
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Surgery
Speciality
Plastic and Reconstructive Surgery
Taxonomy
2086S0122X
License No.
()
Definition
A surgeon who specializes in plastic and reconstructive surgery.
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
-
Taxonomy
363L00000X
License No.
()
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
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