Healthcare Provider Details

I. General information

NPI: 1679120695
Provider Name (Legal Business Name): JENNA VANVELDHUISEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA STEENSMA

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 PARCHMENT DR SE
GRAND RAPIDS MI
49546-3664
US

IV. Provider business mailing address

1003 PARCHMENT DR SE
GRAND RAPIDS MI
49546-3664
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86102233
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: