Healthcare Provider Details

I. General information

NPI: 1013480391
Provider Name (Legal Business Name): MARIA LYNN KURLENDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA LYNN VANDERHOFF

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 E PARIS AVE SE
GRAND RAPIDS MI
49546-6272
US

IV. Provider business mailing address

1724 RODNEY CIR NE
GRAND RAPIDS MI
49505-4439
US

V. Phone/Fax

Practice location:
  • Phone: 616-363-7690
  • Fax: 616-363-7680
Mailing address:
  • Phone: 616-322-5218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704294252
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: