Healthcare Provider Details

I. General information

NPI: 1518822998
Provider Name (Legal Business Name): DEBORAH NASU ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 120212
GRAND RAPIDS MI
49528-0104
US

IV. Provider business mailing address

PO BOX 120212
GRAND RAPIDS MI
49528-0104
US

V. Phone/Fax

Practice location:
  • Phone: 616-498-8454
  • Fax:
Mailing address:
  • Phone: 616-498-8454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number143834122
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: