Provider Demographics
NPI:1750552709
Name:WYKSTRA, DONNA L
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:WYKSTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 VISTA POINT DR
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-9313
Mailing Address - Country:US
Mailing Address - Phone:616-262-9801
Mailing Address - Fax:
Practice Address - Street 1:2294 VISTA POINT DR
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-9313
Practice Address - Country:US
Practice Address - Phone:616-262-9801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist