Healthcare Provider Details

I. General information

NPI: 1063449585
Provider Name (Legal Business Name): LAURA ACKERMAN CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA GELDERLOOS CFNP

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CHERRY ST SE
GRAND RAPIDS MI
49503-4608
US

IV. Provider business mailing address

1900 44TH ST SE
KENTWOOD MI
49508-5008
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-5600
  • Fax: 616-685-6745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704235109
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: