Provider Demographics
NPI:1174547053
Name:BATES, RENEE M (CNM)
Entity type:Individual
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First Name:RENEE
Middle Name:M
Last Name:BATES
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Gender:F
Credentials:CNM
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:616-486-6702
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:MC 020
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-1751
Practice Address - Fax:616-391-2310
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-03-10
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Provider Licenses
StateLicense IDTaxonomies
MI4704162913367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3505170Medicaid
MIS67159Medicare UPIN
MI231858Medicare Oscar/Certification
MI231858Medicare Oscar/Certification