MEDICARE: MRS. ELAINE ANN ENGELSMAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704164318	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MI1763056	OTHER	MI	MEDICARE PTAN

General Provider Information

NPI Number	:	1083822803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELAINE ANN ENGELSMAN NP

Provider Business Mailing Address
First Line	:	4277 OKEMOS RD STE 100
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-3282
Country	:	US
Telephone Number	:	517-816-8723
Fax Number	:	517-247-3558

Provider Business Practice Location Address
First Line	:	4277 OKEMOS RD STE 100
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-3282
Country	:	US
Telephone Number	:	517-816-8723
Fax Number	:	517-247-3558

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	06/01/2026

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