Healthcare Provider Details

I. General information

NPI: 1295720092
Provider Name (Legal Business Name): SARAH KOOP VANDEVEN MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2005
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 PARCHMENT DR SE
GRAND RAPIDS MI
49546-3662
US

IV. Provider business mailing address

970 PARCHMENT DR SE
GRAND RAPIDS MI
49546-3662
US

V. Phone/Fax

Practice location:
  • Phone: 717-843-6663
  • Fax:
Mailing address:
  • Phone: 616-949-4840
  • Fax: 616-949-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR160912
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP008691
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704255877
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: