Provider Demographics
NPI:1700851995
Name:VANDERSCHEER, LYNETTE KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:KAY
Last Name:VANDERSCHEER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:KAY
Other - Last Name:KILROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MICHIGAN ST NE STE 4297
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-267-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001382363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
N48650010Medicare PIN
MIM74460436Medicare PIN
P58373Medicare UPIN
P14500007Medicare PIN