Healthcare Provider Details

I. General information

NPI: 1316693682
Provider Name (Legal Business Name): RACHEL MARY BERLAND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL HARVEY PA

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 E PARIS AVE SE
GRAND RAPIDS MI
49546-6272
US

IV. Provider business mailing address

7502 HESSLER DR NE
ROCKFORD MI
49341-9509
US

V. Phone/Fax

Practice location:
  • Phone: 616-808-2695
  • Fax:
Mailing address:
  • Phone: 616-826-6024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010962
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: