Provider Demographics
NPI:1396900155
Name:WIERKS, REBECCA JEAN (CPNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:WIERKS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JEAN
Other - Last Name:PFEIFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:926 S. WASHINGTON AVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423
Mailing Address - Country:US
Mailing Address - Phone:616-393-0166
Mailing Address - Fax:616-393-8821
Practice Address - Street 1:602 MICHIGAN AVENUE
Practice Address - Street 2:BOVEN BIRTH CENTER
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423
Practice Address - Country:US
Practice Address - Phone:616-393-0166
Practice Address - Fax:616-393-8821
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704282110363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics