Provider Demographics
NPI:1992771398
Name:VEACH, MARY ELYSE (CNM, NP, RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELYSE
Last Name:VEACH
Suffix:
Gender:F
Credentials:CNM, NP, RN
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1310 WISCONSIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2472
Mailing Address - Country:US
Mailing Address - Phone:616-844-4528
Mailing Address - Fax:616-847-5608
Practice Address - Street 1:1445 SHELDON RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2480
Practice Address - Country:US
Practice Address - Phone:616-847-2500
Practice Address - Fax:616-847-6719
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2021-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704189605367A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4557180Medicaid
MIP31360046Medicare PIN
MI4557180Medicaid