Provider Demographics
NPI:1740219609
Name:ROER, GEERTRUIDA C (GNP)
Entity Type:Individual
Prefix:
First Name:GEERTRUIDA
Middle Name:C
Last Name:ROER
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:GEERTRUIDA
Other - Middle Name:C
Other - Last Name:HEULE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2640 87TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9236
Mailing Address - Country:US
Mailing Address - Phone:616-878-1313
Mailing Address - Fax:
Practice Address - Street 1:28800 RYAN RD
Practice Address - Street 2:SUITE 320
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4272
Practice Address - Country:US
Practice Address - Phone:586-620-8100
Practice Address - Fax:866-227-7418
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704142979363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500024152OtherRAILROAD MEDICARE
MI500F410070OtherBCBS
MIP00508Medicare UPIN
MI500024152OtherRAILROAD MEDICARE
MI500F410070OtherBCBS