Provider Demographics
NPI:1124124508
Name:ALEDA E. LUTA VETERANS ADMINISTRATION MEDICAL CENTER
Entity type:Organization
Organization Name:ALEDA E. LUTA VETERANS ADMINISTRATION MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER-MSN, APRN
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-497-2500
Mailing Address - Street 1:10295 SARLE RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-9012
Mailing Address - Country:US
Mailing Address - Phone:989-695-5041
Mailing Address - Fax:
Practice Address - Street 1:10295 SARLE RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-9012
Practice Address - Country:US
Practice Address - Phone:989-695-5041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704118146286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital