Healthcare Provider Details

I. General information

NPI: 1316071301
Provider Name (Legal Business Name): ERICA J NYMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 CASCADE RD SE STE B
GRAND RAPIDS MI
49546-8411
US

IV. Provider business mailing address

5005 CASCADE RD SE STE B
GRAND RAPIDS MI
49546-8411
US

V. Phone/Fax

Practice location:
  • Phone: 616-319-4288
  • Fax: 616-426-6991
Mailing address:
  • Phone: 616-319-4288
  • Fax: 616-426-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004259
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: