Provider Demographics
NPI:1629615646
Name:WOMENS HEALTH COLLECTIVE
Entity Type:Organization
Organization Name:WOMENS HEALTH COLLECTIVE
Other - Org Name:WOMEN'S HEALTH COLLECTIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:616-600-4950
Mailing Address - Street 1:630 KENMOOR AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 KENMOOR AVE SE STE 103
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8626
Practice Address - Country:US
Practice Address - Phone:616-581-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty