Provider Demographics
NPI:1235412701
Name:GROWE, BETTY JEAN (FNP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:GROWE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-8242
Mailing Address - Country:US
Mailing Address - Phone:269-655-1725
Mailing Address - Fax:269-655-0586
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:BOX 42
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-6417
Practice Address - Fax:269-341-8743
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA128747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1235131137OtherBCBSM - BLH
IA1235412701Medicaid
MI1235412701Medicaid
IA1235412701OtherWELLMARK BLUE CROSS BLUE SHIELD
MIH06012731 - BLHMedicare UPIN
IA1235412701Medicaid