Healthcare Provider Details

I. General information

NPI: 1669387890
Provider Name (Legal Business Name): ERICA-JEAN HAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 MARTIN LUTHER KING JR ST SE
GRAND RAPIDS MI
49506-2696
US

IV. Provider business mailing address

1331 MARTIN LUTHER KING JR ST SE HEALTH SERVICES
GRAND RAPIDS MI
49506-2696
US

V. Phone/Fax

Practice location:
  • Phone: 616-819-4673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704265293
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: