Healthcare Provider Details

I. General information

NPI: 1144971086
Provider Name (Legal Business Name): EMILY OBERST FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2682 E GRAND RIVER AVE
EAST LANSING MI
48823-5608
US

IV. Provider business mailing address

2682 E GRAND RIVER AVE
EAST LANSING MI
48823-5608
US

V. Phone/Fax

Practice location:
  • Phone: 517-333-6562
  • Fax: 517-333-6563
Mailing address:
  • Phone: 517-333-6562
  • Fax: 517-333-6563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704280565
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: