Healthcare Provider Details

I. General information

NPI: 1699712042
Provider Name (Legal Business Name): JODI MEINKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 WEALTHY ST SE
GRAND RAPIDS MI
49506-2921
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 109 ATTN JULIE L
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-0351
  • Fax: 616-391-8969
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704210199
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: