Healthcare Provider Details

I. General information

NPI: 1497620611
Provider Name (Legal Business Name): MOLLY VANDERZEE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 COVERED MALL VILLAGE
BELDING MI
48809
US

IV. Provider business mailing address

420 COVERED MALL VILLAGE
BELDING MI
48809
US

V. Phone/Fax

Practice location:
  • Phone: 616-215-2307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: