Healthcare Provider Details

I. General information

NPI: 1265901003
Provider Name (Legal Business Name): ELIZABETH WYGANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2018
Last Update Date: 11/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MICHIGAN AVE W
BATTLE CREEK MI
49017-3602
US

IV. Provider business mailing address

140 MICHIGAN AVE W
BATTLE CREEK MI
49017-3602
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-1460
  • Fax: 269-966-2844
Mailing address:
  • Phone: 269-966-1460
  • Fax: 269-966-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801103535
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: