MEDICARE: JOY BROTHERS BARTHOLOMEW

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	363LF0000X	Family Nurse Practitioner	4704407644	MI

General Provider Information

NPI Number	:	1265498208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY BROTHERS BARTHOLOMEW

Provider Business Mailing Address
First Line	:	2959 LUCERNE DR SE STE 200
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-7173
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 FOREMOST DR SE STE 200
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-7062
Country	:	US
Telephone Number	:	616-389-1800
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	11/09/2023

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Directions to “ JOY BROTHERS BARTHOLOMEW ” Practice Location

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