Provider Demographics
NPI:1376267732
Name:GROOTHUIS, LYNETTE KAY
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:KAY
Last Name:GROOTHUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1729
Mailing Address - Country:US
Mailing Address - Phone:616-502-8759
Mailing Address - Fax:
Practice Address - Street 1:1115 3RD ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2170
Practice Address - Country:US
Practice Address - Phone:231-750-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator