1396900155 NPI number — REBECCA JEAN WIERKS CPNP

Table of content: REBECCA JEAN WIERKS CPNP (NPI 1396900155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396900155 NPI number — REBECCA JEAN WIERKS CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIERKS
Provider First Name:
REBECCA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PFEIFFER
Provider Other First Name:
REBECCA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1396900155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
926 S. WASHINGTON AVE
Provider Second Line Business Mailing Address:
BUILDING C
Provider Business Mailing Address City Name:
HOLLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-393-0166
Provider Business Mailing Address Fax Number:
616-393-8821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 MICHIGAN AVENUE
Provider Second Line Business Practice Location Address:
BOVEN BIRTH CENTER
Provider Business Practice Location Address City Name:
HOLLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-393-0166
Provider Business Practice Location Address Fax Number:
616-393-8821
Provider Enumeration Date:
07/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  4704282110 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)