Healthcare Provider Details

I. General information

NPI: 1174924906
Provider Name (Legal Business Name): JESSICA LERCH ZOLLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ERIN LERCH

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 FELCH ST
ZEELAND MI
49464-2608
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-935-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704278072
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: