Provider Demographics
NPI:1447236765
Name:HOSTETLER, JANET (CNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:HOSTETLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 CHERRY ST SE
Practice Address - Street 2:STE 306
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4607
Practice Address - Country:US
Practice Address - Phone:616-685-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704291697363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HONP07061OtherMEDICARE PTAN
0700191OtherUHC PIN
311413469054OtherCARESOURCE PIN
OH0989499OtherGROUP MEDICAID
OH2013430Medicaid
500015909OtherMEDICARE RAILROAD PIN
CA1586OtherGROUP MEDICARE RAILROAD
HONP07061Medicare PIN
OH0989499OtherGROUP MEDICAID
S90637Medicare UPIN