Provider Demographics
NPI:1992249510
Name:VANDYK, CATHERINE M (NP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:VANDYK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 HEALTH PKWY STE G
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-8242
Mailing Address - Country:US
Mailing Address - Phone:269-668-3348
Mailing Address - Fax:269-668-7702
Practice Address - Street 1:451 HEALTH PKWY STE G
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079
Practice Address - Country:US
Practice Address - Phone:269-668-3348
Practice Address - Fax:269-668-7702
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704137102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily