Basic Information
| Provider Information | |||||||||
| NPI: | 1194248815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUIZENGA | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 PATTERSON AVE SE STE 125 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495129627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162225601 | ||||||||
| FaxNumber: | 8669417479 | ||||||||
| Practice Location | |||||||||
| Address1: | 5300 PATTERSON AVE SE STE 125 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162225601 | ||||||||
| FaxNumber: | 8669417479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WH0200X | 4704295830 | MI | Y | Nursing Service Providers | Registered Nurse | Home Health |
No ID Information.