Healthcare Provider Details

I. General information

NPI: 1306557640
Provider Name (Legal Business Name): RACHEL DIANE SATHER GERLEMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHERRY ST SE
GRAND RAPIDS MI
49503-4526
US

IV. Provider business mailing address

3649 JOLLY OAK RD UNIT B1109
OKEMOS MI
48864-2563
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-8209
  • Fax:
Mailing address:
  • Phone: 218-839-9466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601011127
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: