Provider Demographics
NPI:1184968349
Name:VERIGAN, GEORGANNE ROBERTA (PHD, LAC)
Entity type:Individual
Prefix:
First Name:GEORGANNE
Middle Name:ROBERTA
Last Name:VERIGAN
Suffix:
Gender:F
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E LAKESHORE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854-1692
Mailing Address - Country:US
Mailing Address - Phone:906-286-0198
Mailing Address - Fax:
Practice Address - Street 1:601 E LAKESHORE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-1692
Practice Address - Country:US
Practice Address - Phone:906-286-0198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000068171100000X
NHNH-140171100000X
WI649-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist