Provider Demographics
NPI:1447802111
Name:VIERA-VANARKEL, NATALIA
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:VIERA-VANARKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NATALIA
Other - Middle Name:
Other - Last Name:VIERA-VANARKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3017 PLAINFIELD AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3258
Mailing Address - Country:US
Mailing Address - Phone:616-447-0622
Mailing Address - Fax:
Practice Address - Street 1:3017 PLAINFIELD AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3258
Practice Address - Country:US
Practice Address - Phone:517-256-7815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS410397304103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities