Healthcare Provider Details

I. General information

NPI: 1851173603
Provider Name (Legal Business Name): ANISA VICTORIA-ACEVEDO BOOKMYER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANISA ACEVEDO

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 04/26/2024
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HOUGHTON AVE
SAGINAW MI
48602-5303
US

IV. Provider business mailing address

1000 HOUGHTON AVE
SAGINAW MI
48602-5303
US

V. Phone/Fax

Practice location:
  • Phone: 989-746-7500
  • Fax:
Mailing address:
  • Phone: 989-746-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4704326536
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704326536
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: