Healthcare Provider Details

I. General information

NPI: 1922888213
Provider Name (Legal Business Name): RACHEL ANNE HOUSTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MICHIGAN ST NW STE 424
GRAND RAPIDS MI
49503-3799
US

IV. Provider business mailing address

493 STONE FALLS DR SE APT 207
ADA MI
49301-7948
US

V. Phone/Fax

Practice location:
  • Phone: 248-563-7875
  • Fax: 616-200-6412
Mailing address:
  • Phone: 248-563-7875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704359535
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: