Provider Demographics
NPI:1649647876
Name:HARBOUR TOWNE HEALTH PLLC
Entity type:Organization
Organization Name:HARBOUR TOWNE HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:231-375-8065
Mailing Address - Street 1:131 W SEAWAY DR
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3759
Mailing Address - Country:US
Mailing Address - Phone:231-375-8065
Mailing Address - Fax:231-375-8063
Practice Address - Street 1:131 W SEAWAY DR
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3759
Practice Address - Country:US
Practice Address - Phone:231-375-8065
Practice Address - Fax:231-375-8063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010623941041C0700X
MI5601002156363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty