Provider Demographics
NPI:1619212156
Name:HACKETT, RHONDA LYNN (FNP-BC)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:LYNN
Last Name:HACKETT
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:LYNN
Other - Last Name:POBANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:235 WEALTHY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5247
Mailing Address - Country:US
Mailing Address - Phone:616-840-7135
Mailing Address - Fax:616-840-9690
Practice Address - Street 1:700 COOPER AVE STE 1100
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5383
Practice Address - Country:US
Practice Address - Phone:989-583-2720
Practice Address - Fax:989-583-1888
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704242724363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily