Healthcare Provider Details

I. General information

NPI: 1558157446
Provider Name (Legal Business Name): HAUWA KIEKOVER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 STOCKING AVE NW
GRAND RAPIDS MI
49504-5176
US

IV. Provider business mailing address

669 STOCKING AVE NW
GRAND RAPIDS MI
49504-5176
US

V. Phone/Fax

Practice location:
  • Phone: 616-235-1480
  • Fax:
Mailing address:
  • Phone: 616-617-6730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704326329
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: