Provider Demographics
NPI:1609244029
Name:VEREB, JAMES EDWARD (LPN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:VEREB
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-9514
Mailing Address - Country:US
Mailing Address - Phone:906-458-4080
Mailing Address - Fax:
Practice Address - Street 1:480 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841-9514
Practice Address - Country:US
Practice Address - Phone:906-458-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703079492164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse