Individual
TANIA DEE VANDYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1310 WISCONSIN ST STE 301, GRAND HAVEN, MI 49417-2472
(616) 296-1550
(616) 296-1554
Mailing address
1310 WISCONSIN ST STE 101, GRAND HAVEN, MI 49417-2472
(616) 296-1550
(616) 296-6155
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704145235
MI
363LG0600X
Gerontology Nurse Practitioner
Primary
4704145235
MI
Other
Enumeration date
07/12/2005
Last updated
01/04/2022
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