Healthcare Provider Details

I. General information

NPI: 1700530045
Provider Name (Legal Business Name): NATALIE ZUKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 EASTCASTLE DR SE STE B
GRAND RAPIDS MI
49508-8873
US

IV. Provider business mailing address

2013 EASTCASTLE DR SE STE B
GRAND RAPIDS MI
49508-8873
US

V. Phone/Fax

Practice location:
  • Phone: 616-888-1120
  • Fax: 616-469-1113
Mailing address:
  • Phone: 616-888-1120
  • Fax: 616-469-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: