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General NPI Number Information
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NPI Number | 1043745730
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Entity Type | Organization
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Legal Business Name | DEGARA APP HM, PLLC
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 401 W GREENLAWN AVE
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City | LANSING
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State | MI
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Zip | 48910-2819
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Country | US
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Telephone | 517-975-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 5121 MARYLAND WAY SUITE 300
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City | BRENTWOOD
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State | TN
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Zip | 37027-7516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP
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Name | CHARLES SOMERBY
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Credential |
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Telephone | 615-928-6264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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