Provider Demographics
NPI:1477058030
Name:FEIRICK, BROOKE ELISABETH
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELISABETH
Last Name:FEIRICK
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 1:97 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4771
Mailing Address - Country:US
Mailing Address - Phone:616-796-0685
Mailing Address - Fax:
Practice Address - Street 1:1115 BALL AVE NE BLDG A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5904
Practice Address - Country:US
Practice Address - Phone:616-456-6571
Practice Address - Fax:616-235-0979
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist