Provider Demographics
NPI:1790880664
Name:VANDERHOEF, JONNIE D (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JONNIE
Middle Name:D
Last Name:VANDERHOEF
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E WARWICK DR
Mailing Address - Street 2:PO BOX 423
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1014
Mailing Address - Country:US
Mailing Address - Phone:989-463-4418
Mailing Address - Fax:989-463-5900
Practice Address - Street 1:300 E WARWICK DR
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1014
Practice Address - Country:US
Practice Address - Phone:989-463-4418
Practice Address - Fax:989-463-5900
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704137528367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOB91026OtherBCBS PROVIDER NUMBER
MIOB91026OtherBCBS PROVIDER NUMBER