Provider Demographics
NPI:1205134509
Name:OAKLAND UNIVERSITY GHC
Entity type:Organization
Organization Name:OAKLAND UNIVERSITY GHC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-370-2341
Mailing Address - Street 1:2200 N SQUIRREL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48309-4402
Mailing Address - Country:US
Mailing Address - Phone:248-370-2341
Mailing Address - Fax:
Practice Address - Street 1:2200 N SQUIRREL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48309-4402
Practice Address - Country:US
Practice Address - Phone:248-370-2341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKLAND UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI50-0-F3-1791-0OtherBCBS