Healthcare Provider Details

I. General information

NPI: 1700794534
Provider Name (Legal Business Name): ELIZABETH R NASSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 E DIVISION ST
ROCKFORD MI
49341-1305
US

IV. Provider business mailing address

6210 MAKSIMOWSKI AVE NE
BELMONT MI
49306-9700
US

V. Phone/Fax

Practice location:
  • Phone: 312-909-7276
  • Fax:
Mailing address:
  • Phone: 312-909-7276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851102613
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: