Healthcare Provider Details

I. General information

NPI: 1649550120
Provider Name (Legal Business Name): HEATHER NORDEN FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2011
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 S RIVER AVE
HOLLAND MI
49423-3326
US

IV. Provider business mailing address

4700 32ND AVE
HUDSONVILLE MI
49426-8001
US

V. Phone/Fax

Practice location:
  • Phone: 616-394-3788
  • Fax: 616-662-2222
Mailing address:
  • Phone: 616-662-2011
  • Fax: 616-662-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704255319
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704255319
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001232748
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: