Provider Demographics
NPI:1639895253
Name:HAZEKAMP, ERYCA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ERYCA
Middle Name:
Last Name:HAZEKAMP
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11273 EVERT CT
Mailing Address - Street 2:
Mailing Address - City:WEST OLIVE
Mailing Address - State:MI
Mailing Address - Zip Code:49460-9581
Mailing Address - Country:US
Mailing Address - Phone:480-789-1633
Mailing Address - Fax:
Practice Address - Street 1:1475 ROBBINS RD STE 150
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-3700
Practice Address - Country:US
Practice Address - Phone:616-237-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704373409363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health