Individual
REBECCA VENEKLASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
801 BROADWAY AVE NW STE 105, GRAND RAPIDS, MI 49504-4496
(616) 685-7500
(616) 685-7511
Mailing address
801 BROADWAY AVE NW STE 105, GRAND RAPIDS, MI 49504-4496
(616) 685-7500
(616) 685-7511
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704313199
MI
Other
Enumeration date
07/15/2019
Last updated
12/20/2021
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