Healthcare Provider Details

I. General information

NPI: 1275905481
Provider Name (Legal Business Name): BRITTANY MICHELE GEERDES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY MICHELE WOODALL

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3271 CLEAR VISTA CT NE
GRAND RAPIDS MI
49525-9477
US

IV. Provider business mailing address

3394 E JOLLY RD SUITE C
LANSING MI
48910-8594
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-7293
  • Fax:
Mailing address:
  • Phone: 517-272-9700
  • Fax: 517-272-9706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704313080
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: