Provider Demographics
NPI:1417395997
Name:ALLEGIANCE HEALTH
Entity Type:Organization
Organization Name:ALLEGIANCE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MUEGGENBORG
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:405-408-6500
Mailing Address - Street 1:1404 W. NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202
Mailing Address - Country:US
Mailing Address - Phone:517-782-2555
Mailing Address - Fax:
Practice Address - Street 1:1362 HEATHERWOOD LN
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2813
Practice Address - Country:US
Practice Address - Phone:405-408-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care