1952462913 NPI number — MRS. RHONDA ANN DEYOUNG NP

Table of content: MRS. RHONDA ANN DEYOUNG NP (NPI 1952462913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952462913 NPI number — MRS. RHONDA ANN DEYOUNG NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEYOUNG
Provider First Name:
RHONDA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VOLKERS
Provider Other First Name:
RHONDA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1952462913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MICHIGAN ST NE
Provider Second Line Business Mailing Address:
MC 845
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49503-2560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-486-6800
Provider Business Mailing Address Fax Number:
616-486-6345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 MICHIGAN ST NE
Provider Second Line Business Practice Location Address:
SPECTRUM HEALTH HOSPITAL
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-2562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-486-6800
Provider Business Practice Location Address Fax Number:
616-486-6345
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  4704232909 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4704232909 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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