Provider Demographics
NPI:1124280219
Name:PETTINGA, JAYNE DEUR (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:DEUR
Last Name:PETTINGA
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Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:3200 KNIGHT WAY SE
Mailing Address - Street 2:CALVIN COLLEGE HEALTH SERVICES
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4407
Mailing Address - Country:US
Mailing Address - Phone:616-526-6187
Mailing Address - Fax:616-526-6548
Practice Address - Street 1:3200 KNIGHT WAY SE
Practice Address - Street 2:CALVIN COLLEGE HEALTH SERVICES
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4407
Practice Address - Country:US
Practice Address - Phone:616-526-6187
Practice Address - Fax:616-526-6548
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
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Provider Licenses
StateLicense IDTaxonomies
MI4704119236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily