Healthcare Provider Details

I. General information

NPI: 1740839505
Provider Name (Legal Business Name): RACHEL LAUREN ZOKOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-6045
US

IV. Provider business mailing address

1574 MOUNT MERCY DR NW
GRAND RAPIDS MI
49504-4905
US

V. Phone/Fax

Practice location:
  • Phone: 616-320-0096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601009425
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: