Provider Demographics
NPI:1518019223
Name:GRAND VALLEY STATE UNIVERSITY
Entity Type:Organization
Organization Name:GRAND VALLEY STATE UNIVERSITY
Other - Org Name:GVSU FAMILY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE DEAN. DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINTNALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:616-331-3338
Mailing Address - Street 1:72 SHELDON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4234
Mailing Address - Country:US
Mailing Address - Phone:616-988-8774
Mailing Address - Fax:616-988-8775
Practice Address - Street 1:72 SHELDON BLVD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4234
Practice Address - Country:US
Practice Address - Phone:616-988-8774
Practice Address - Fax:616-988-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty