Provider Demographics
NPI:1386949436
Name:CALDWELL, LUKE A (NURSE PRACTIONER)
Entity type:Individual
Prefix:MR
First Name:LUKE
Middle Name:A
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:NURSE PRACTIONER
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Mailing Address - Street 1:721 3 MILE RD NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8229
Mailing Address - Country:US
Mailing Address - Phone:616-647-3770
Mailing Address - Fax:616-647-3776
Practice Address - Street 1:721 3 MILE RD NW
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8229
Practice Address - Country:US
Practice Address - Phone:616-647-3770
Practice Address - Fax:616-647-3776
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIF0910484363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF0910484OtherLICENSE