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General NPI Number Information
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NPI Number | 1184816183
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Entity Type | Organization
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Legal Business Name | SAINT MARY'S HOSPITAL
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 200 JEFFERSON LACKS CANCER CENTER
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City | GRAND RAPIDS
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State | MI
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Zip | 49503
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Country | US
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Telephone | 616-752-5828
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Fax |
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Provider Business Mailing Address
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Address Line | 7477 CROOKED CREEK DR SW
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City | BYRON CENTER
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State | MI
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Zip | 49315-8136
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Country | US
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Telephone | 616-485-2792
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. LAURA LYNN GELDERLOOS
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Credential | RN, CFNP
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Telephone | 616-485-2792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 4704235109
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License Number State | MI
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