Lisa Vanmaele, CPNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704155720 Issued in MI

Practice address

4190 24TH Ave Ste 204
Fort Gratiot, MI 48059-3884

Phone

(810) 216-1000

Fax

(810) 216-3138

NPI assigned

Oct 15, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1841628633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 24TH AVE STE 204",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593884",
            "telephone_number": "810-216-1000",
            "fax_number": "810-216-3138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 24TH AVE STE 204",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593884",
            "telephone_number": "810-216-1000",
            "fax_number": "810-216-3138"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36267 26 Mile Rd Ste 3",
            "address_purpose": "LOCATION",
            "city": "Lenox",
            "state": "MI",
            "postal_code": "480483253",
            "country_code": "US",
            "telephone_number": "586-716-1371",
            "fax_number": "586-716-4855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANMAELE",
        "first_name": "LISA",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-15",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704155720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.