Individual
LOIS R DYKSTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3019 COIT NE, GRAND RAPIDS, MI 49505
(616) 365-9575
Mailing address
5104 BIRCH, LAKEVIEW, MI 48850
(989) 352-6564
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
4704153985
MI
Other
Enumeration date
10/02/2006
Last updated
07/08/2007
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