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General NPI Number Information
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NPI Number | 1073606059
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Entity Type | Individual
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Provider Name | LOIS R DYKSTRA RN
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3019 COIT NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505
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Country | US
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Telephone | 616-365-9575
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Fax |
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Provider Business Mailing Address
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Address Line | 5104 BIRCH
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City | LAKEVIEW
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State | MI
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Zip | 48850
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Country | US
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Telephone | 989-352-6564
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 4704153985
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License Number State | MI
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