Healthcare Provider Details

I. General information

NPI: 1598140303
Provider Name (Legal Business Name): FAITH VAN OSS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FAITH RODENHOUSE NP

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LAFAYETTE AVE SE STE 415
GRAND RAPIDS MI
49503-4693
US

IV. Provider business mailing address

1900 44TH ST SE
KENTWOOD MI
49508-5008
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-5666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704226391
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: