Healthcare Provider Details

I. General information

NPI: 1043154925
Provider Name (Legal Business Name): KATIE DEMING NORMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 E PARIS AVE SE
GRAND RAPIDS MI
49546-6204
US

IV. Provider business mailing address

1740 E PARIS AVE SE
GRAND RAPIDS MI
49546-6204
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-5600
  • Fax: 616-949-6571
Mailing address:
  • Phone: 616-949-5600
  • Fax: 616-949-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704384203
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: