Provider Demographics
NPI:1750537924
Name:BOND, BEVERLY ANN (NP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:BOND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:ANN
Other - Last Name:PULLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
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 1:2111 12 MILE RD NW
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-9754
Practice Address - Country:US
Practice Address - Phone:616-391-8470
Practice Address - Fax:616-391-8495
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704134193363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICA8440OtherRAILROAD MEDICARE PTAN
MICA8440OtherRAILROAD MEDICARE PTAN