Provider Demographics
NPI:1083822803
Name:ENGELSMAN, ELAINE ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:ANN
Last Name:ENGELSMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:A
Other - Last Name:LEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:D-NP
Mailing Address - Street 1:1675 LEAHY ST STE 301A
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5543
Mailing Address - Country:US
Mailing Address - Phone:231-672-8300
Mailing Address - Fax:231-672-8310
Practice Address - Street 1:1675 LEAHY ST STE 301A
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5543
Practice Address - Country:US
Practice Address - Phone:231-672-8300
Practice Address - Fax:231-672-8310
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704164318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1763056OtherMEDICARE PTAN
MIMI1763056OtherMEDICARE PTAN