Van Gorden, Traci J

Van Gorden, Traci J is an individual health care provider with primary practice located at 104 S Lakeview Ave , Sturgis MI 49091-1947. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Van Gorden, Traci J can be contacted via phone (269) 319-8850.

Contact Information

Primary practice address
104 S Lakeview Ave Sturgis MI 49091-1947
Phone: (269) 319-8850
Fax: (269) 464-0101
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 4704252117 Michigan

Profile Details

NPI number 1679513451
LBN Legal business name Van Gorden, Traci J
Credentials Certified Family Nurse Practitioner (CFNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2006
Last updated Nov 5th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679513451 NPPES
Michigan MEDICAID 4888010
Michigan MEDICAID 4887990

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