Individual
ERIC RANDALL DEJONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP
Contact information
Practice address
602 MICHIGAN AVE STE 102, HOLLAND, MI 49423-4918
(616) 494-8724
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
4704295254
MI
Other
Enumeration date
10/08/2019
Last updated
10/14/2022
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