Healthcare Provider Details

I. General information

NPI: 1992215768
Provider Name (Legal Business Name): HEATHER METZ AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 PARK EAST CT SE
GRAND RAPIDS MI
49546-8810
US

IV. Provider business mailing address

3067 WOODGLEN ST NW
GRAND RAPIDS MI
49504-3604
US

V. Phone/Fax

Practice location:
  • Phone: 616-727-0083
  • Fax: 866-493-3535
Mailing address:
  • Phone: 231-288-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704268537
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: