Healthcare Provider Details

I. General information

NPI: 1619086329
Provider Name (Legal Business Name): NANCY ANN INSIDIOSO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 E WELLS STREET
SOUTH HAVEN MI
49090-9612
US

IV. Provider business mailing address

801 HAZEN STREET SUITE C PO BOX 249
PAW PAW MI
49079-0249
US

V. Phone/Fax

Practice location:
  • Phone: 269-637-5297
  • Fax: 269-637-9238
Mailing address:
  • Phone: 269-657-5574
  • Fax: 269-657-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: