Healthcare Provider Details

I. General information

NPI: 1912723982
Provider Name (Legal Business Name): ERICA BORSUM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3912 32ND AVE
HUDSONVILLE MI
49426-8460
US

IV. Provider business mailing address

3912 32ND AVE
HUDSONVILLE MI
49426-8460
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-7200
  • Fax: 616-252-8750
Mailing address:
  • Phone: 616-252-7200
  • Fax: 616-252-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: