Provider Demographics
NPI:1558029983
Name:ADVANCED PRACTICE PRIMARY CARE STAFF ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED PRACTICE PRIMARY CARE STAFF ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN OVERBERGHE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,APRN,FNP-C
Authorized Official - Phone:574-485-9541
Mailing Address - Street 1:27160 DEERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9663
Mailing Address - Country:US
Mailing Address - Phone:574-485-9541
Mailing Address - Fax:
Practice Address - Street 1:27160 DEERFIELD LN
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112-9663
Practice Address - Country:US
Practice Address - Phone:574-485-9541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care