Provider Demographics
NPI:1528691193
Name:VISSER, YOLANDA (CPM)
Entity type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:
Last Name:VISSER
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 NORWOOD AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2712
Mailing Address - Country:US
Mailing Address - Phone:616-450-2320
Mailing Address - Fax:
Practice Address - Street 1:1514 WEALTHY ST SE STE 238
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2755
Practice Address - Country:US
Practice Address - Phone:616-458-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7601000014176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife