Provider Demographics
NPI:1245741651
Name:MICHIGAN BORN AND RAISED LLC
Entity type:Organization
Organization Name:MICHIGAN BORN AND RAISED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/HEALTH EDUCATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:KRISTIN
Authorized Official - Last Name:GARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, EMT
Authorized Official - Phone:231-557-7118
Mailing Address - Street 1:19702 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:CONKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:49403-9562
Mailing Address - Country:US
Mailing Address - Phone:231-557-7118
Mailing Address - Fax:
Practice Address - Street 1:2932 CHICAGO DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1176
Practice Address - Country:US
Practice Address - Phone:231-557-7118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty