Provider Demographics
NPI:1376211912
Name:GOORHOUSE, NATALIE (RN)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:GOORHOUSE
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 1:1642 MARGARET AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-2230
Mailing Address - Country:US
Mailing Address - Phone:616-822-0757
Mailing Address - Fax:
Practice Address - Street 1:1642 MARGARET AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-2230
Practice Address - Country:US
Practice Address - Phone:616-822-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704330431163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse