Provider Demographics
NPI:1063449585
Name:ACKERMAN, LAURA (CFNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:GELDERLOOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:1900 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4608
Practice Address - Country:US
Practice Address - Phone:616-685-5600
Practice Address - Fax:616-685-6745
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200338221OtherTRICARE
MA5008705720OtherBCBSM
MI4823034Medicaid
MI200338221OtherTRICARE
MIQ65370Medicare UPIN