Provider Demographics
NPI:1265484067
Name:MEAD, JAMES J (FNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:MEAD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 W OAK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1575
Practice Address - Country:US
Practice Address - Phone:231-924-4200
Practice Address - Fax:231-924-2001
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI141896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE26557Medicare UPIN
MI2851595Medicaid
MIO8756595502Medicare ID - Type UnspecifiedMEDICARE NUMBER