MEDICARE: MS. ELIZABETH ANNE VAN OVERBERGHE FNP

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	71011176	IN
2	363LF0000X	Family Nurse Practitioner	4704215544NSA21037	MI

General Provider Information

NPI Number	:	1558954495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH ANNE VAN OVERBERGHE FNP

Provider Business Mailing Address
First Line	:	51531 BITTERSWEET RD
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-9120
Country	:	US
Telephone Number	:	269-357-7613
Fax Number	:	833-794-1822

Provider Business Practice Location Address
First Line	:	51531 BITTERSWEET RD
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-9120
Country	:	US
Telephone Number	:	269-357-7613
Fax Number	:	833-941-1822

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

Provider Enumeration Date	:	02/11/2021
Last Update Date	:	03/09/2026

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