Healthcare Provider Details

I. General information

NPI: 1013429323
Provider Name (Legal Business Name): LAURA CHRISTINE GERENCER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 E LAKEWOOD BLVD FL 1
HOLLAND MI
49424-2023
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-494-5800
  • Fax: 616-494-5901
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704285213
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: