Provider Demographics
NPI:1295051209
Name:DEHAAN, NATASHA D (NP)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:D
Last Name:DEHAAN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
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 1:4069 LAKE DR SE STE 118
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8816
Practice Address - Country:US
Practice Address - Phone:616-267-8520
Practice Address - Fax:616-363-0724
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2021-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704245179363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM71280058Medicare PIN
MI0M74460292Medicare PIN