Healthcare Provider Details

I. General information

NPI: 1528691193
Provider Name (Legal Business Name): YOLANDA VISSER CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 WEALTHY ST SE STE 238
GRAND RAPIDS MI
49506-2755
US

IV. Provider business mailing address

515 NORWOOD AVE SE
GRAND RAPIDS MI
49506-2712
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-8144
  • Fax:
Mailing address:
  • Phone: 616-450-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number7601000014
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: