Provider Demographics
NPI:1700307204
Name:VANDERWEELE, NATHAN JOHN
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JOHN
Last Name:VANDERWEELE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 TIOGA DR SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-3130
Mailing Address - Country:US
Mailing Address - Phone:616-217-7708
Mailing Address - Fax:
Practice Address - Street 1:3907 TIOGA DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-3130
Practice Address - Country:US
Practice Address - Phone:616-217-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst