Otsego Family Medical Practice, PLLC
Organization Active NPI Family Nurse Practitioner · Gobles, MI
NPI 1801920533 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1801920533
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 4704142595 (MI)
- Legal business name
- OTSEGO FAMILY MEDICAL PRACTICE, PLLC
- Practice address
- 34471 North Dr
Gobles, MI 49055-9670 - Phone
- (269) 628-2789
- NPI assigned
- Mar 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Fred D Boothby, CNP
- Title
- Owner
- Phone
- (269) 628-4997
Practitioners 3
-
Fred Boothby, CNP
-
Patrick J Dougherty, PA C
-
Susan Mathews, M D
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | 4704142595 | MI | Yes |
Addresses
Primary practice location
34471 North Dr
Gobles, MI 49055-9670
Mailing address
34471 North Dr
Gobles, MI 49055-9670
Phone (269) 628-2789
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All providers in Gobles, MI · Family Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.