Healthcare Provider Details

I. General information

NPI: 1225169261
Provider Name (Legal Business Name): ANGELA CHRISTINE ELENBAAS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. ANGELA CHRISTINE BERG

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MCPHERSON AVE
LANSING MI
48915-1760
US

IV. Provider business mailing address

5303 S CEDAR ST
LANSING MI
48911-3800
US

V. Phone/Fax

Practice location:
  • Phone: 517-244-8041
  • Fax: 517-244-7189
Mailing address:
  • Phone: 517-887-4467
  • Fax: 517-244-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704190660
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704190660
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: