Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 4704227055 | MI |
NPI | 1023660321 |
---|---|
Provider Name | Dr. Cheri Van Wyngarden |
First Address | Belmont, MI 49306-8712 |
Second Address | Belmont, MI 49306-8711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2019 |
Last Update Date | 16/10/2020 |