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Organization

MICHIGAN STATE UNIVERSITY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LISA RUCKER (ENROLLMENT & PATIENT ACCTS MANAGER)
(517) 884-2976
Entity
Organization

Contact information

Practice address
804 SERVICE RD STE A142, EAST LANSING, MI 48824-7015
(517) 353-3050
(517) 432-3742
Mailing address
804 SERVICE RD # A109F, EAST LANSING, MI 48824-7015
(517) 884-2976
(517) 432-3928

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
207RR0500X
Rheumatology Physician
363A00000X
Physician Assistant
363LF0000X
Family Nurse Practitioner
Primary
363LG0600X
Gerontology Nurse Practitioner
363LP0200X
Pediatric Nurse Practitioner
363LW0102X
Women's Health Nurse Practitioner

Other

Enumeration date
10/25/2006
Last updated
04/05/2018
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