Individual
GRETCHEN S HOLT-VREDEVOOGD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
145 MICHIGAN ST NE STE 3410, GRAND RAPIDS, MI 49503-2563
(616) 391-9945
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601004218
MI
363AM0700X
Medical Physician Assistant
Primary
5601004218
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00345069
RAILROAD MEDICARE
MI
Enumeration date
08/19/2006
Last updated
02/17/2021
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