Healthcare Provider Details

I. General information

NPI: 1861325854
Provider Name (Legal Business Name): ANGYL MARIE TABER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11410 E LENNON RD
LENNON MI
48449-9666
US

IV. Provider business mailing address

5352 SMITH DR
FLUSHING MI
48433-9009
US

V. Phone/Fax

Practice location:
  • Phone: 989-494-0553
  • Fax: 989-494-0554
Mailing address:
  • Phone: 989-494-0553
  • Fax: 989-494-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: