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General NPI Number Information
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NPI Number | 1831099571
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Entity Type | Individual
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Provider Name | JENNIFERANN VANDYKEN
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Gender |
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 2774 BIRCHCREST DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-5477
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Country | US
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Telephone | 616-988-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 315 ANN ST
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City | COOPERSVILLE
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State | MI
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Zip | 49404-1120
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Country | US
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Telephone | 760-717-9067
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704362065
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License Number State | MI
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