Healthcare Provider Details

I. General information

NPI: 1164432886
Provider Name (Legal Business Name): JULIE ANN HATFIELD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE ANN VESEY PA

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3264 N EVERGREEN DR NE
GRAND RAPIDS MI
49525-9746
US

IV. Provider business mailing address

3264 N EVERGREEN DR NE
GRAND RAPIDS MI
49525-9746
US

V. Phone/Fax

Practice location:
  • Phone: 616-363-7272
  • Fax: 616-363-7290
Mailing address:
  • Phone: 616-363-7272
  • Fax: 616-363-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004624
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: