Healthcare Provider Details

I. General information

NPI: 1780925404
Provider Name (Legal Business Name): LIZBETH GABEL MACCORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 COBB ST
CADILLAC MI
49601-2540
US

IV. Provider business mailing address

527 COBB ST
CADILLAC MI
49601-2540
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-3463
  • Fax: 231-775-1692
Mailing address:
  • Phone: 231-775-3463
  • Fax: 231-775-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704184078
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704184078
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704184078
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: