Individual
DARBY RAE DISSELKOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APRN, CPNP-PC
Contact information
Practice address
8333 FELCH ST STE 200, ZEELAND, MI 49464-2609
(616) 748-2850
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704320802
MI
Other
Enumeration date
09/21/2021
Last updated
12/13/2021
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