Healthcare Provider Details

I. General information

NPI: 1326398215
Provider Name (Legal Business Name): NANCY F BANDSTRA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY FERN RAYEL

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 06/24/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 LAFAYETTE AVE SE STE 400
GRAND RAPIDS MI
49503-4677
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-486-6870
  • Fax:
Mailing address:
  • Phone: 616-391-2957
  • Fax: 616-391-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301015406
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: