MICHIGAN STATE UNIVERSITY (NPI# 1639253784) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639253784 |
| Entity Type | Organization |
| Organization Name | MICHIGAN STATE UNIVERSITY |
| Practice Address |
804 Service Rd Ste A142 East Lansing MI 48824-7015 |
| Mailing Address |
804 Service Rd # A109f East Lansing MI 48824-7015 |
| Practice Telephone | 5173533050 |
| Practice Fax Number | 5174323742 |
| Mailing Telephone | 5178842976 |
| Mailing Fax Number | 5174323928 |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2018-04-05 |
| Authorized Official Name | LISA RUCKER (ENROLLMENT & PATIENT ACCTS MANAGER) |
| Authorized Official Telephone | 5178842976 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | Nursing Service Providers | ||
| N | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184182982 | Michigan State University | Local Education Agency (LEA) | 446 W. Circle Drive, Room 409, Justin S. Morrill Hall of Agriculture, East Lansing, MI 48824-1039 | 2019-03-11 |
| 1427443274 | Michigan State University | Behavioral Analyst | 325 W Grand River Ave, East Lansing, MI 48823 | 2015-03-30 |
| 1629307251 | Michigan State University | Preventive Medicine | 346 Olin Health Ctr, East Circle Drive, East Lansing, MI 48824-1037 | 2009-12-10 |
| 1295978054 | Michigan State University | Clinical Medical Laboratory | 1355 Bogue St Rm B228, East Lansing, MI 48824-6207 | 2009-04-09 |
| 1487780565 | Michigan State University | Clinical Medical Laboratory | B228 Life Sciences Bldg, East Lansing, MI 48824 | 2007-02-26 |
| 1518046598 | Michigan State University | Clinic/Center | 804 Clinical Center, A114, East Lansing, MI 48824-1313 | 2006-11-02 |
| 1962515221 | Michigan State University | Pharmacy | 463 E Circle Dr. Rm103, East Lansing, MI 48824 | 2006-08-17 |
| 1992712053 | Michigan State University | Occupational Therapist | 4660 S Hagadorn Rd Ste 400, East Lansing, MI 48823-5353 | 2006-08-02 |
| 1891747614 | Michigan State University | Radiology | 804 Service Rd # D100, East Lansing, MI 48824-7015 | 2006-05-17 |
| 1861443269 | Michigan State University | Family Medicine | 804 Service Rd # A225, East Lansing, MI 48824-7015 | 2006-05-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MICHIGAN STATE UNIVERSITY | 426 Auditorium Rd, East Lansing, MI 48824-2600 |
| Virginia Business Entities | Michigan State University Alumni Club of Metropolitan Washington DC | 10511 Judicial Drive, Fairfax, Virginia 22030-5172 |
| System for Award Management (SAM) Entities | MICHIGAN STATE UNIVERSITY FOUNDATION | 2727 Alliance Dr Ste C, Lansing, MI 48910-3868 |
| Street Address |
804 SERVICE RD STE A142 |
| City | EAST LANSING |
| State | MI |
| Zip Code | 48824-7015 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508242447 | Patrick Charles Crane | Nurse Practitioner | 804 Service Rd Ste A142, East Lansing, MI 48824-7015 | 2015-08-03 |
| 1356540116 | Carrie S Sandborn | Family Medicine | 804 Service Rd Ste A142, East Lansing, MI 48824-7015 | 2007-07-12 |
| 1245316090 | Claudia A Finkelstein | Internal Medicine | 804 Service Rd Ste A142, East Lansing, MI 48824 | 2006-10-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528680303 | Emilia Elizabeth Mattioli | Psychiatry & Neurology | 965 Fee Road Room A223, East Lansing, MI 48824 | 2020-05-14 |
| 1447871983 | James O'brien | Psychiatry & Neurology | Msu Psychiatry Residency Program, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2020-05-06 |
| 1750916979 | Mulin Xiong | Student in an Organized Health Care Education/Training Program | 965 Wilson Road Suite A110, East Fee Hall, East Lansing, MI 48824 | 2020-03-09 |
| 1821659301 | Tovah Apolonia Aho | Psychiatry & Neurology | Michigan State University Psychiatric Residency, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-06-25 |
| 1912564881 | Asmara Theresa Hoo | Psychiatry & Neurology | 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-05-24 |
| 1790276822 | Traverse Health Clinic and Coalition | Clinic/Center | East Fee Hall 965 Fee Road, Room A222, East Lansing, MI 48824 | 2018-05-24 |
| 1922598515 | Jubin Joseph Cheruvelil | Specialist/Technologist, Other | 446 W. Circle Dr. Room 249 Annex, Justin S. Morrill Hall of Agriculture, East Lansing, MI 48824 | 2018-05-18 |
| 1073003257 | Dawn Arvye Contreras | Health Educator | 446 West Circle Dr., Justin S. Morrill Hall of Agriculture, Room 166, East Lansing, MI 48824 | 2018-05-14 |
| 1710406046 | Kimberly Ann Breukink | Social Worker | 463 East Circle Drive, Michigan State University, Counseling and Psychiatric Services, East Lansing, MI 48824 | 2017-09-19 |
| 1043766314 | Ahmed Jouan | Psychiatry & Neurology | 804 Service Rd A217, East Lansing, MI 48824 | 2016-08-28 |
| Find all providers in zip 48824 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538585252 | Andria Elizabeth Slater | Nurse Practitioner | 660 Cornell Ave, East Lansing, MI 48823-3609 | 2014-03-06 |
| 1275840209 | Nora Longthorne | Nurse Practitioner | 535 Aquila Dr, East Lansing, MI 48823-8318 | 2010-09-13 |
| 1831144237 | Katherine J Dontje | Nurse Practitioner | A142 Clinical Ctr, College of Nursing, East Lansing, MI 48824-1313 | 2006-05-23 |
| 1205436375 | Danielle Lyndsey Engwis | Nurse Practitioner | 2025 Abbot Rd Ste 100, East Lansing, MI 48823-8573 | 2020-10-28 |
| 1568001394 | Andrea Lee Hanna | Nurse Practitioner | 2900 Hannah Blvd, East Lansing, MI 48823 | 2019-12-26 |
| 1174085484 | Abigail Ann Whitten | Nurse Practitioner | 2682 E Grand River Ave, East Lansing, MI 48823-5608 | 2019-04-04 |
| 1679049308 | Kimberly A Loomis | Nurse Practitioner | 6110 Abbot Rd, East Lansing, MI 48823-1410 | 2018-10-20 |
| 1578068235 | Christopher E Title | Nurse Practitioner | 6200 Pine Hollow Dr Ste 400, East Lansing, MI 48823-9224 | 2018-03-26 |
| 1487156808 | Karyn Tetloff | Nurse Practitioner | 804 Service Rd Ste A217, East Lansing, MI 48824-7015 | 2018-03-01 |
| 1114465952 | Elise Langley | Nurse Practitioner | 4650 S Hagadorn Rd Ste 100, East Lansing, MI 48823-5386 | 2017-01-31 |
| Find all providers in EAST LANSING | ||||
| City | EAST LANSING |
| Zip Code | 48824 |
Please comment or provide details below to improve the information on MICHIGAN STATE UNIVERSITY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.