Healthcare Provider Details

I. General information

NPI: 1851440424
Provider Name (Legal Business Name): JANINE MARIE KERKSTRA PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANINE MARIE WALTEREIT PAC

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 CENTURY LN SUITE 2
HOLLAND MI
49423
US

IV. Provider business mailing address

503 CENTURY LN SUITE 2
HOLLAND MI
49423
US

V. Phone/Fax

Practice location:
  • Phone: 616-295-8284
  • Fax: 616-834-0446
Mailing address:
  • Phone: 616-295-8284
  • Fax: 616-834-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601004513
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004513
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: