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General NPI Number Information
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NPI Number | 1881666501
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Entity Type | Individual
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Provider Name | DEBORAH A VLIET NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 06/07/2019
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Provider Practice Location Address
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Address Line | 5515 CLEVELAND AVE SUITE 5
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City | STEVENSVILLE
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State | MI
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Zip | 49127-9670
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Country | US
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Telephone | 269-429-9644
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Fax | 269-429-4002
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Provider Business Mailing Address
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Address Line | 5515 CLEVELAND AVE
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City | STEVENSVILLE
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State | MI
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Zip | 49127-9670
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Country | US
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Telephone | 269-429-9644
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Fax | 269-429-4002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704137020
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License Number State | MI
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