Healthcare Provider Details

I. General information

NPI: 1285805242
Provider Name (Legal Business Name): BARBARA C OPPERWALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 RAYBROOK ST SE
GRAND RAPIDS MI
49546-7759
US

IV. Provider business mailing address

2100 RAYBROOK ST SE
GRAND RAPIDS MI
49546-7759
US

V. Phone/Fax

Practice location:
  • Phone: 616-235-5101
  • Fax: 616-949-9020
Mailing address:
  • Phone: 616-252-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704123565
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: