Healthcare Provider Details

I. General information

NPI: 1477058030
Provider Name (Legal Business Name): BROOKE ELISABETH FEIRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BALL AVE NE BLDG A
GRAND RAPIDS MI
49505-5904
US

IV. Provider business mailing address

97 W 22ND ST
HOLLAND MI
49423-4771
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-6571
  • Fax: 616-235-0979
Mailing address:
  • Phone: 616-796-0685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: