Healthcare Provider Details

I. General information

NPI: 1447802111
Provider Name (Legal Business Name): NATALIA VIERA-VANARKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. NATALIA VIERA-VANARKEL

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 PLAINFIELD AVE NE
GRAND RAPIDS MI
49505-3258
US

IV. Provider business mailing address

3017 PLAINFIELD AVE NE
GRAND RAPIDS MI
49505-3258
US

V. Phone/Fax

Practice location:
  • Phone: 517-256-7815
  • Fax:
Mailing address:
  • Phone: 616-447-0622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberAS410397304
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: