Provider Demographics
NPI:1316397995
Name:DEGEER, ALIESA
Entity Type:Individual
Prefix:
First Name:ALIESA
Middle Name:
Last Name:DEGEER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W BENNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9750
Mailing Address - Country:US
Mailing Address - Phone:989-640-5677
Mailing Address - Fax:
Practice Address - Street 1:120 W BENNINGTON RD
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9750
Practice Address - Country:US
Practice Address - Phone:989-640-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703103149164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse