Healthcare Provider Details

I. General information

NPI: 1154202786
Provider Name (Legal Business Name): LIANA DYKEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 MICHIGAN AVE
HOLLAND MI
49423-4918
US

IV. Provider business mailing address

400 136TH AVE STE 416
HOLLAND MI
49424-2905
US

V. Phone/Fax

Practice location:
  • Phone: 616-392-5141
  • Fax:
Mailing address:
  • Phone: 616-952-9957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704374209
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: