Healthcare Provider Details

I. General information

NPI: 1306370036
Provider Name (Legal Business Name): NATALIE DAWN BEVERSLUIS B.S., M.ED., L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 EAGLE PARK DR NE 107
GRAND RAPIDS MI
49525-7004
US

IV. Provider business mailing address

845 FOUNTAIN ST NE
GRAND RAPIDS MI
49503-3557
US

V. Phone/Fax

Practice location:
  • Phone: 616-617-3760
  • Fax:
Mailing address:
  • Phone: 616-617-3760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501003899
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: