Healthcare Provider Details

I. General information

NPI: 1558609461
Provider Name (Legal Business Name): AMY E KAMPHUIS RN, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 LEONARD ST NE
GRAND RAPIDS MI
49505-5515
US

IV. Provider business mailing address

1450 LEONARD ST NE
GRAND RAPIDS MI
49505-5515
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-8789
  • Fax: 616-776-1305
Mailing address:
  • Phone: 616-774-8789
  • Fax: 616-776-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number4703103984
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704305053
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704305053
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: