Provider Demographics
NPI:1376244376
Name:VANZALEN, LILY (PA-C)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:VANZALEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:BOERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 MICHIGAN ST NE STE 3100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2563
Mailing Address - Country:US
Mailing Address - Phone:616-954-9800
Mailing Address - Fax:
Practice Address - Street 1:145 MICHIGAN ST NE STE 3100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2563
Practice Address - Country:US
Practice Address - Phone:616-954-9800
Practice Address - Fax:616-954-1724
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant