Healthcare Provider Details

I. General information

NPI: 1922651322
Provider Name (Legal Business Name): AMBER LYNN VANDENBOS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 ROOST AVE
HOLLAND MI
49424-2032
US

IV. Provider business mailing address

5327 EAGLE PASS DR
HUDSONVILLE MI
49426-9529
US

V. Phone/Fax

Practice location:
  • Phone: 616-377-4655
  • Fax:
Mailing address:
  • Phone: 937-376-4457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704373321
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPN.0994775-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: