| NPI | LastName | FirstName | MidName | Organization | Mailing Address | City | State | Zip |
| 1295054237 | CONVERY | JUDY | ANN | 1221 PINE GROVE AVE | PORT HURON | MI | 480603511 | |
| 1871014944 | LAKE | DONALD | 1221 PINE GROVE AVE | PORT HURON | MI | 48060 | ||
| 1013459320 | STOREY | AMY | 1221 PINE GROVE AVE | PORT HURON | MI | 480603511 |