Basic Information
| Provider Information | |||||||||
| NPI: | 1972060960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IGOE | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 TOWNER ST | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481985723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345443000 | ||||||||
| FaxNumber: | 7345446716 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 TOWNER ST | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481985723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345443000 | ||||||||
| FaxNumber: | 7345446716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2019 | ||||||||
| LastUpdateDate: | 06/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4704313596 | MI | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 4704313596 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.