Provider Demographics
NPI:1184816183
Name:SAINT MARY'S HOSPITAL
Entity Type:Organization
Organization Name:SAINT MARY'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GELDERLOOS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CFNP
Authorized Official - Phone:616-485-2792
Mailing Address - Street 1:7477 CROOKED CREEK DR SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8136
Mailing Address - Country:US
Mailing Address - Phone:616-485-2792
Mailing Address - Fax:
Practice Address - Street 1:200 JEFFERSON LACKS CANCER CENTER
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-752-5828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235109282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital