Provider Demographics
NPI:1417717687
Name:ANSPACH, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:ANSPACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:802 S MAIN ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1779
Mailing Address - Country:US
Mailing Address - Phone:517-663-6036
Mailing Address - Fax:
Practice Address - Street 1:802 S MAIN ST UNIT A
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-1779
Practice Address - Country:US
Practice Address - Phone:517-663-6036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB260108564647OtherSTATE IDENTIFICATION NUMBER/DRIVER'S LICENSE NUMBER