Provider Demographics
NPI:1356776207
Name:BALKEMA, RACHEL S (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:S
Last Name:BALKEMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:S
Other - Last Name:WITTUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1150 E SHERMAN BLVD STE 2400
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1886
Mailing Address - Country:US
Mailing Address - Phone:231-672-4243
Mailing Address - Fax:231-727-4214
Practice Address - Street 1:1150 E SHERMAN BLVD STE 2400
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1886
Practice Address - Country:US
Practice Address - Phone:231-672-4243
Practice Address - Fax:231-727-4214
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006791363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant