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General NPI Number Information
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NPI Number | 1922592294
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Entity Type | Individual
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Provider Name | SARA DOEZEMA
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Gender | Female
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 5500 BURTON ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6711
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Country | US
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Telephone | 616-855-9687
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Fax |
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Provider Business Mailing Address
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Address Line | 3973 RIVERBEND DR SW
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City | GRAND RAPIDS
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State | MI
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Zip | 49534-6610
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Country | US
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Telephone |
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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