MEDICARE: MITCHELL A VAN OVERLOOP

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	163WE0003X	Emergency Registered Nurse	4704289600	MI

General Provider Information

NPI Number	:	1851258065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL A VAN OVERLOOP

Provider Business Mailing Address
First Line	:	5178 NEW HOLLAND ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9565
Country	:	US
Telephone Number	:	616-988-8220
Fax Number	:

Provider Business Practice Location Address
First Line	:	5178 NEW HOLLAND ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9565
Country	:	US
Telephone Number	:	616-988-8220
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ MITCHELL A VAN OVERLOOP ” Practice Location

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