Healthcare Provider Details

I. General information

NPI: 1952742488
Provider Name (Legal Business Name): JANA LEA VAN ENK B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E BELTLINE AVE SE
GRAND RAPIDS MI
49506-4336
US

IV. Provider business mailing address

1490 E BELTLINE AVE SE
GRAND RAPIDS MI
49506-4336
US

V. Phone/Fax

Practice location:
  • Phone: 616-940-0040
  • Fax: 616-940-8151
Mailing address:
  • Phone: 616-940-0040
  • Fax: 616-940-8151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: