Provider Demographics
NPI:1306370036
Name:BEVERSLUIS, NATALIE DAWN (BS, MED, LMT)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:DAWN
Last Name:BEVERSLUIS
Suffix:
Gender:F
Credentials:BS, MED, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 FOUNTAIN ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3557
Mailing Address - Country:US
Mailing Address - Phone:616-617-3760
Mailing Address - Fax:
Practice Address - Street 1:3355 EAGLE PARK DR NE
Practice Address - Street 2:107
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7004
Practice Address - Country:US
Practice Address - Phone:616-617-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003899225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist