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HomeProvidersMCLAREN BAY REGION

Family Medicine

MCLAREN BAY REGION

Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.

Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.

Public record

NPI 1629357090 · enumerated 2011-08-16 · record updated 2018-08-07. Source: CMS NPPES. A listing is not a TRICARE network approval.

NPPES record Google Maps Apple Maps OpenStreetMap

Authorized official: DANIELLE JACKS PORTER, CFO · (989) 894-3838

Addresses and phones

Mailing address 200 GRAND AVE, PO BOX 679, PRUDENVILLE, MI, 48651-9571 (989) 366-1000 Fax (989) 366-1002 Google Maps Apple Maps OpenStreetMap
Practice location 200 GRAND AVE, PRUDENVILLE, MI, 48651 (989) 366-1000 Fax (989) 366-1002 Google Maps Apple Maps OpenStreetMap

Specialties

Nurse Practitioner, Pediatrics 363LP0200X
Internal Medicine 207R00000X
Physician Assistant 363A00000X
Nurse Practitioner, Family 363LF0000X
Nurse Practitioner, Gerontology 363LG0600X
Family Medicine 207Q00000X · Primary

In this directory

MI Roscommon County Prudenville Family Medicine

Locations and evidence

Practice location PRUDENVILLE, MI, 48651
Accepting new patientsNot reportedCMS NPPES · September 30, 2026

Plan acceptance

No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.