Provider Demographics
NPI:1215044904
Name:HOEKSEMA, DAVID BRUCE (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:HOEKSEMA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1247 OLD LAKE CT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4352
Mailing Address - Country:US
Mailing Address - Phone:269-945-2176
Mailing Address - Fax:269-945-0885
Practice Address - Street 1:999 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7722
Practice Address - Country:US
Practice Address - Phone:616-396-5493
Practice Address - Fax:616-396-0085
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704113698367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4313264Medicaid
MIQMXPR0028402OtherMOLINA HEALTHCARE
MI4308752770OtherBCBS MICHIGAN
MI4313264Medicaid
MIQMXPR0028402OtherMOLINA HEALTHCARE