Healthcare Provider Details

I. General information

NPI: 1396512638
Provider Name (Legal Business Name): MS. ALLYSON MARIE DYKLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 MARYLAND AVE NE
GRAND RAPIDS MI
49505-6005
US

IV. Provider business mailing address

891 MARYLAND AVE NE
GRAND RAPIDS MI
49505-6005
US

V. Phone/Fax

Practice location:
  • Phone: 616-608-7772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: