MEDICARE: MARY ELYSE VEACH CNM, NP, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	4704189605	MI
2	363LF0000X	Family Nurse Practitioner	4704189605	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992771398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELYSE VEACH CNM, NP, RN

Provider Business Mailing Address
First Line	:	1310 WISCONSIN AVE
Second Line	:	SUITE 101
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2472
Country	:	US
Telephone Number	:	616-844-4528
Fax Number	:	616-847-5608

Provider Business Practice Location Address
First Line	:	1445 SHELDON RD
Second Line	:	SUITE 301
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2480
Country	:	US
Telephone Number	:	616-847-2500
Fax Number	:	616-847-6719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	02/17/2021

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