Provider Demographics
NPI:1467075630
Name:VANREYENDAM, RHIANNON ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:RHIANNON
Middle Name:ROSE
Last Name:VANREYENDAM
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Gender:
Credentials:PA-C
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Mailing Address - Street 1:37098 CAMELOT DR APT 8
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2454
Mailing Address - Country:US
Mailing Address - Phone:248-459-4047
Mailing Address - Fax:
Practice Address - Street 1:37921 HURON POINTE DR
Practice Address - Street 2:
Practice Address - City:HARRISON TWP
Practice Address - State:MI
Practice Address - Zip Code:48045-2830
Practice Address - Country:US
Practice Address - Phone:248-459-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601009947TMP20363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant