MEDICARE: EVANGELINE MARIE DEGLOPPER

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	385H00000X	Respite Care	AFO30080043	MI

General Provider Information

NPI Number	:	1780953000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVANGELINE MARIE DEGLOPPER

Provider Business Mailing Address
First Line	:	3151 136TH AVE
Second Line	:
City	:	HAMILTON
State	:	MI
Zip	:	49419-9548
Country	:	US
Telephone Number	:	616-896-7433
Fax Number	:

Provider Business Practice Location Address
First Line	:	3151 136TH AVE
Second Line	:
City	:	HAMILTON
State	:	MI
Zip	:	49419-9548
Country	:	US
Telephone Number	:	616-896-7433
Fax Number	:

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

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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