Basic Information
| Provider Information | |||||||||
| NPI: | 1740219609 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROER | ||||||||
| FirstName: | GEERTRUIDA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | GNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HEULE | ||||||||
| OtherFirstName: | GEERTRUIDA | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2640 87TH ST SW | ||||||||
| Address2: | |||||||||
| City: | BYRON CENTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493159236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168781313 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 28800 RYAN RD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480924272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866208100 | ||||||||
| FaxNumber: | 8662277418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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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 | 363LG0600X | 4704142979 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 500024152 | 01 | MI | RAILROAD MEDICARE | OTHER | 500F410070 | 01 | MI | BCBS | OTHER |