MEDICARE: MRS. DEBORAH A VLIET NP-C

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	363L00000X	Nurse Practitioner	4704137020	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	I31674	OTHER		UPIN
2	1538397120	OTHER	MI	GROUP NPI

General Provider Information

NPI Number	:	1881666501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH A VLIET NP-C

Provider Business Mailing Address
First Line	:	5515 CLEVELAND AVE
Second Line	:
City	:	STEVENSVILLE
State	:	MI
Zip	:	49127-9670
Country	:	US
Telephone Number	:	269-429-9644
Fax Number	:	269-429-4002

Provider Business Practice Location Address
First Line	:	5515 CLEVELAND AVE
Second Line	:	SUITE 5
City	:	STEVENSVILLE
State	:	MI
Zip	:	49127-9670
Country	:	US
Telephone Number	:	269-429-9644
Fax Number	:	269-429-4002

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	06/07/2019

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