Healthcare Provider Details

I. General information

NPI: 1831303668
Provider Name (Legal Business Name): JAMIE LYNN RODRIGUEZ WHNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MIDTOWNE STREET NE SUITE 400
GRAND RAPIDS MI
49503-5731
US

IV. Provider business mailing address

555 MIDTOWNE STREET NE SUITE 400
GRAND RAPIDS MI
49503-5731
US

V. Phone/Fax

Practice location:
  • Phone: 616-588-1200
  • Fax: 616-588-1250
Mailing address:
  • Phone: 616-588-1200
  • Fax: 616-588-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704228492
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: