Individual
PAMELA VANDUSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
200 JEFFERSON SE, GRAND RAPIDS, MI 49503
(616) 685-1835
(616) 685-1846
Mailing address
1900 44TH ST SE, KENTWOOD, MI 49508
(616) 965-8200
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704165365
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700832995
—
MI
Enumeration date
05/26/2006
Last updated
04/01/2014
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