Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301088446 | MI |
Y | 2080P0210X | Pediatric Nephrologist | 4301088446 | MI |
NPI | 1962621383 |
---|---|
Provider Name | Mrs. Natalie A Van Venrooij |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 31/12/2013 |