Healthcare Provider Details

I. General information

NPI: 1174365035
Provider Name (Legal Business Name): MISS TERI BUIKEMA I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13872 OAKWOOD CIR
GRAND HAVEN MI
49417-9582
US

IV. Provider business mailing address

13872 OAKWOOD CIR
GRAND HAVEN MI
49417-9582
US

V. Phone/Fax

Practice location:
  • Phone: 616-834-1686
  • Fax:
Mailing address:
  • Phone: 616-607-8098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: