MEDICARE: WENDY JANE KOOPMAN N.P.

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	4704195455	MI

General Provider Information

NPI Number	:	1891728069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY JANE KOOPMAN N.P.

Provider Business Mailing Address
First Line	:	5800 FOREMOST DR SE STE 300
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-7062
Country	:	US
Telephone Number	:	616-954-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 FOREMOST DR SE STE 100
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-7062
Country	:	US
Telephone Number	:	616-954-5554
Fax Number	:

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	03/13/2020

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