Individual
MR. BRADLEY ALLEN VANDERHULST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
1713 7TH ST, MUSKEGON, MI 49441-2426
(231) 726-1214
Mailing address
960 WOLF RIVER CT NW, WALKER, MI 49534-3460
(616) 644-2084
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703111898
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4703111898
LARA
MI
Enumeration date
01/22/2021
Last updated
11/04/2021
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