Provider Demographics
NPI:1467457143
Name:DEVRIES, PATRICIA MARIA (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIA
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:616-296-1600
Mailing Address - Fax:616-296-1602
Practice Address - Street 1:1310 WISCONSIN ST STE 100
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2472
Practice Address - Country:US
Practice Address - Phone:616-296-1600
Practice Address - Fax:616-296-1604
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704168822363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N33890OtherMEDICARE GROUP PIN
MIM74460357Medicare PIN