Provider Demographics
NPI:1043225782
Name:ZECH, ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ZECH
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:42 N SAINT JOSEPH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2203
Mailing Address - Country:US
Mailing Address - Phone:269-687-0808
Mailing Address - Fax:269-687-0811
Practice Address - Street 1:42 N SAINT JOSEPH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2203
Practice Address - Country:US
Practice Address - Phone:269-687-0808
Practice Address - Fax:269-687-0811
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704088490363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1043225782Medicaid
MIMI2051093Medicare PIN