Provider Demographics
NPI:1306883475
Name:DOORENBOS, ELIZABETH ERIN (LPN)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ERIN
Last Name:DOORENBOS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 VINTON AVE NW
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-8311
Mailing Address - Country:US
Mailing Address - Phone:616-785-2727
Mailing Address - Fax:
Practice Address - Street 1:6545 13 MILE RD NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9714
Practice Address - Country:US
Practice Address - Phone:616-866-9393
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703089697164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse