Provider Demographics
NPI:1467143826
Name:UBER-HAAG, AMY ELIZABETH (RNBSN,TNCC,ENPC,ACL)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:UBER-HAAG
Suffix:
Gender:F
Credentials:RNBSN,TNCC,ENPC,ACL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 PENNOYER AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1935
Mailing Address - Country:US
Mailing Address - Phone:616-843-5079
Mailing Address - Fax:
Practice Address - Street 1:1135 PENNOYER AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1935
Practice Address - Country:US
Practice Address - Phone:616-843-5079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty