Individual
JENNIFER B DYKHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
743 E BELTLINE AVE NE, GRAND RAPIDS, MI 49525-6045
(616) 456-9553
(616) 454-5371
Mailing address
510 S FAIR ST, OTSEGO, MI 49078-1402
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601004859
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601004859
LICENSE
MI
Enumeration date
11/21/2006
Last updated
05/23/2023
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