DEBRA K PROVOAST (NPI# 1033107271) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033107271 |
| Entity Type | Individual |
| Full Name | DEBRA K PROVOAST |
| Credential | NP |
| Practice Address |
3190 Northridge Drive Hale MI 48739-9276 |
| Mailing Address |
Po Box 279 Hale MI 48739-0279 |
| Practice Telephone | 9897286000 |
| Practice Fax Number | 9897286003 |
| Mailing Telephone | 9897286000 |
| Mailing Fax Number | 9897286003 |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2014-03-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
4704173663 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 105235126 | 05 | |
| MI | LICENSE | DP173663 | 01 |
| MI | BCBS | 500C510200 | 01 |
| Street Address |
3190 NORTHRIDGE DRIVE |
| City | HALE |
| State | MI |
| Zip Code | 48739-9276 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447248703 | Beth A Weaver | Nurse Practitioner | 3190 Northridge Drive, Hale, MI 48739-9276 | 2005-10-11 |
| 1780803932 | Northridge Family Practice LLC | Internal Medicine | 3190 Northridge Drive, Hale, MI 48739-9276 | 2007-04-25 |
| 1891712493 | Northridge Family Practice LLC | Internal Medicine | 3190 Northridge Drive, Hale, MI 48739-9276 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346703162 | Lisa Kay Devine | Social Worker | 4093 N M-65, Hale, MI 48739 | 2019-04-09 |
| 1558571158 | Hale Chiropractic PC | Chiropractor | 110 E. Main St., Hale, MI 48739 | 2007-05-23 |
| 1801862966 | Winston A Bailey | Dentist | 116 Victoria St, Hale, MI 48739 | 2006-02-27 |
| 1992114706 | Midland Sleep Central | Durable Medical Equipment & Medical Supplies | 415 E Main St, Hale, MI 48739 | 2014-08-06 |
| 1669751129 | Mclaren Bay Region | Internal Medicine | 436 W Main St, Hale, MI 48739 | 2011-08-15 |
| 1457408916 | Hometown Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 3270 M 65, Hale, MI 48739-8509 | 2007-01-05 |
| 1689012619 | Vera Jo Smock | Pharmacist | 3270 M 65, Hale, MI 48739-8509 | 2013-06-12 |
| 1457959363 | Baruch Sls, Inc. | Assisted Living Facility | 3191 M 65, Hale, MI 48739-8512 | 2020-10-13 |
| 1750367793 | Shannon Kay Chrivia | Chiropractor | 3141 M 65, Hale, MI 48739-8512 | 2005-12-21 |
| 1952960197 | Thunder Bay Community Health Service, Inc | Clinic/Center | 311 N Washington St Rm Tb1, Hale, MI 48739-8516 | 2019-06-11 |
| Find all providers in zip 48739 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447248703 | Beth A Weaver | Nurse Practitioner | 3190 Northridge Drive, Hale, MI 48739-9276 | 2005-10-11 |
| 1518528710 | Amanda Breault | Nurse Practitioner | 3190 Northridge Rd, Hale, MI 48739-9276 | 2019-06-27 |
| 1306366562 | Lydia Jordan Leonard | Nurse Practitioner | 3190 Northridge Rd, Hale, MI 48739-9276 | 2017-06-20 |
| 1518330257 | Lindsey Grace | Nurse Practitioner | 3190 Northridge Rd, Hale, MI 48739-9276 | 2015-11-03 |
| 1669722401 | Melissa Marie Nixon | Nurse Practitioner | 3190 Northridge Rd, Hale, MI 48739-9276 | 2012-09-19 |
| 1093073041 | Shannon Marie Michaud | Nurse Practitioner | 116 S Church St, Hale, MI 48739-9272 | 2012-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659972339 | Zeinab Berjaoui | Nurse Practitioner | 11496 Newbern Dr, Warren, MI 48093-2613 | 2020-11-08 |
| 1134720899 | Whitney Ashton Mervau | Nurse Practitioner | 3836 Haven Hill Ln, Williamsburg, MI 49690-9536 | 2020-11-07 |
| 1063013837 | Amy Lynn Wadsworth | Nurse Practitioner | 9259 Chambord Dr, Ypsilanti, MI 48197-9281 | 2020-11-06 |
| 1821699844 | Michelle Daldine | Nurse Practitioner | 38481 Gail St, Clinton Township, MI 48036-1823 | 2020-11-05 |
| 1710588876 | Coty Cole | Nurse Practitioner | 2065 South Center Rd, Ste A, Burton, MI 48519 | 2020-11-05 |
| 1205437175 | Michelle Jo Whitesel | Nurse Practitioner | 5861 Shadow Pines Ct, Howell, MI 48843-7130 | 2020-11-05 |
| 1326649617 | Melinda Lee Hawley | Nurse Practitioner | 4019 Stark Dr, West Branch, MI 48661-9633 | 2020-11-04 |
| 1720689193 | Mohammed Louthfur Rahman | Nurse Practitioner | Hoover Internal Medicine Pllc, 2930 Holbrook St, Hamtramck, MI 48212 | 2020-11-03 |
| 1619578234 | Devon Kruger | Nurse Practitioner | 4612 W David Hwy, Saranac, MI 48881-9740 | 2020-11-02 |
| 1760083208 | Ramonna Van Alstine | Nurse Practitioner | 13932 Fox Ridge Ln, Allenton, MI 48002-4525 | 2020-11-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.