Healthcare Provider Details

I. General information

NPI: 1992573422
Provider Name (Legal Business Name): ERIN RITSEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4065 E HILLS CT SE
GRAND RAPIDS MI
49546-6249
US

IV. Provider business mailing address

9101 BROWN RD
LAKE ODESSA MI
48849-9447
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2081
  • Fax:
Mailing address:
  • Phone: 616-466-1373
  • 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: