Provider Demographics
NPI:1730164658
Name:ROZEMA, JOANNE (FNP)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:ROZEMA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6105 WILSON AVE SW
Practice Address - Street 2:SUITE 204
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-9714
Practice Address - Country:US
Practice Address - Phone:616-486-5421
Practice Address - Fax:616-486-5051
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704082062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4113497Medicaid
MIOM98130009Medicare ID - Type Unspecified
MI4113497Medicaid