Healthcare Provider Details

I. General information

NPI: 1396556619
Provider Name (Legal Business Name): RACHEL ELIZABETH LAFRANCE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL ELIZABETH CRUDEN

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 EAGLE RUN DR NE STE 100
GRAND RAPIDS MI
49525-7051
US

IV. Provider business mailing address

3210 EAGLE RUN DR NE STE 100
GRAND RAPIDS MI
49525-7051
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-9553
  • Fax: 616-454-5371
Mailing address:
  • Phone: 616-456-9553
  • Fax: 616-454-5371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: