Basic Information
| Provider Information | |||||||||
| NPI: | 1992249510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANDYK | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 451 HEALTH PKWY STE G | ||||||||
| Address2: | |||||||||
| City: | PAW PAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490798242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696683348 | ||||||||
| FaxNumber: | 2696687702 | ||||||||
| Practice Location | |||||||||
| Address1: | 451 HEALTH PKWY STE G | ||||||||
| Address2: | |||||||||
| City: | PAW PAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696683348 | ||||||||
| FaxNumber: | 2696687702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2016 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704137102 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.