Provider Demographics
NPI:1235407347
Name:HUIZINGA, DOLORES ANNE (RN)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:ANNE
Last Name:HUIZINGA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9415 E 136TH ST
Mailing Address - Street 2:
Mailing Address - City:SAND LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49343-8976
Mailing Address - Country:US
Mailing Address - Phone:616-636-8160
Mailing Address - Fax:
Practice Address - Street 1:9415 E 136TH ST
Practice Address - Street 2:
Practice Address - City:SAND LAKE
Practice Address - State:MI
Practice Address - Zip Code:49343-8976
Practice Address - Country:US
Practice Address - Phone:616-636-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704134859163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse