Healthcare Provider Details

I. General information

NPI: 1780169367
Provider Name (Legal Business Name): LINDSEY KATHRYN WEESIES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY KATHRYN VANDENHEUVEL

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 LEAHY ST STE 428B
MUSKEGON MI
49442-5500
US

IV. Provider business mailing address

3065 WEESIES RD
MONTAGUE MI
49437-9551
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-3300
  • Fax:
Mailing address:
  • Phone: 231-893-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704243821
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: