Provider Demographics
NPI:1295013571
Name:VANDER SYS, ERICKA LEE (CNM)
Entity Type:Individual
Prefix:MS
First Name:ERICKA
Middle Name:LEE
Last Name:VANDER SYS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:ERICKA
Other - Middle Name:LEE
Other - Last Name:BOUNDS FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
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 1:100 MICHIGAN ST NE
Practice Address - Street 2:MC 020
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-1751
Practice Address - Fax:616-391-2310
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704291521367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife