Healthcare Provider Details

I. General information

NPI: 1407656275
Provider Name (Legal Business Name): SYDNEY FINN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 LAKE DR SE STE 101
GRAND RAPIDS MI
49546-8294
US

IV. Provider business mailing address

4070 LAKE DR SE STE 101
GRAND RAPIDS MI
49546-8294
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-4114
  • Fax: 616-455-4454
Mailing address:
  • Phone: 616-455-4114
  • Fax: 616-455-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013072
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: