Provider Demographics
NPI:1730639709
Name:VANDERVEST, MEGAN (DOULA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:VANDERVEST
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 MONTCALM AVE NE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-9372
Mailing Address - Country:US
Mailing Address - Phone:616-450-8193
Mailing Address - Fax:
Practice Address - Street 1:646 MONTCALM AVE NE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-9372
Practice Address - Country:US
Practice Address - Phone:616-450-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula