Healthcare Provider Details

I. General information

NPI: 1205477924
Provider Name (Legal Business Name): SAMANTHA METTE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 EDGEWATER DR
ALLENDALE MI
49401-9396
US

IV. Provider business mailing address

11315 EDGEWATER DR
ALLENDALE MI
49401-9396
US

V. Phone/Fax

Practice location:
  • Phone: 616-895-2000
  • Fax:
Mailing address:
  • Phone: 616-895-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704308643
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: