Provider Demographics
NPI:1427822121
Name:VAN DYKE, ROSANNE (MA)
Entity type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:VAN DYKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E MAIN ST UNIT 71
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2376
Mailing Address - Country:US
Mailing Address - Phone:269-340-2770
Mailing Address - Fax:
Practice Address - Street 1:210 E MAIN ST UNIT 71
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2376
Practice Address - Country:US
Practice Address - Phone:269-340-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach