MEDICARE: MELINDA HUIZENGA RN

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
1	163WH0200X	Home Health Registered Nurse	4704295830	MI

General Provider Information

NPI Number	:	1194248815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA HUIZENGA RN

Provider Business Mailing Address
First Line	:	5300 PATTERSON AVE SE STE 125
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49512-9627
Country	:	US
Telephone Number	:	616-222-5601
Fax Number	:	866-941-7479

Provider Business Practice Location Address
First Line	:	5300 PATTERSON AVE SE STE 125
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49512
Country	:	US
Telephone Number	:	616-222-5601
Fax Number	:	866-941-7479

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	07/21/2022

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