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NPI Code Detail

MEDICARE: LIANA DYKEMA

MEDICARE: LIANA DYKEMA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner4704374209MI

General Provider Information

NPI Number : 1154202786
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIANA DYKEMA
Provider Business Mailing Address
First Line : 400 136TH AVE STE 416
Second Line :
City : HOLLAND
State : MI
Zip : 49424-2905
Country : US
Telephone Number : 616-952-9957
Fax Number : 616-369-1400
Provider Business Practice Location Address
First Line : 400 136TH AVE STE 416
Second Line :
City : HOLLAND
State : MI
Zip : 49424-2905
Country : US
Telephone Number : 616-952-9957
Fax Number : 616-369-1400
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2025
Last Update Date : 12/30/2025

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Directions to “ LIANA DYKEMA ” Practice Location

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