Provider Demographics
NPI:1780630020
Name:ZUIDEMA, ANNE MARIE (GNP-C)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:ZUIDEMA
Suffix:
Gender:F
Credentials:GNP-C
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:BAREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1310 WISCONSIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2472
Mailing Address - Country:US
Mailing Address - Phone:616-844-4528
Mailing Address - Fax:616-847-5608
Practice Address - Street 1:1310 WISCONSIN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2472
Practice Address - Country:US
Practice Address - Phone:616-847-1860
Practice Address - Fax:616-844-4537
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704222044363LG0600X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4654030Medicaid
MI4654030Medicaid