Provider Demographics
NPI:1780953000
Name:DEGLOPPER, EVANGELINE MARIE
Entity type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:MARIE
Last Name:DEGLOPPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MI
Mailing Address - Zip Code:49419-9548
Mailing Address - Country:US
Mailing Address - Phone:616-896-7433
Mailing Address - Fax:
Practice Address - Street 1:3151 136TH AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MI
Practice Address - Zip Code:49419-9548
Practice Address - Country:US
Practice Address - Phone:616-896-7433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAFO30080043385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care