Healthcare Provider Details

I. General information

NPI: 1609448364
Provider Name (Legal Business Name): MARTA BYMA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 WASHINGTON AVE STE 2700
HOLLAND MI
49423-7139
US

IV. Provider business mailing address

844 WASHINGTON AVE STE 2700
HOLLAND MI
49423-7139
US

V. Phone/Fax

Practice location:
  • Phone: 616-748-5785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704316801
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number28228728A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: