Provider Demographics
NPI:1568075364
Name:VANDERWOUDE, LUCILLE YURKO (DNP)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:YURKO
Last Name:VANDERWOUDE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:LUCILLE
Other - Middle Name:MARIE
Other - Last Name:YURKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8214 PFEIFFER FARMS DR SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8288
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 RAYBROOK ST SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5782
Practice Address - Country:US
Practice Address - Phone:616-235-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704318801363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care