Provider Demographics
NPI:1023660321
Name:VAN WYNGARDEN, CHERI (NP)
Entity type:Individual
Prefix:DR
First Name:CHERI
Middle Name:
Last Name:VAN WYNGARDEN
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 1:6250 JUPITER AVE NE
Mailing Address - Street 2:STE A
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-8712
Mailing Address - Country:US
Mailing Address - Phone:517-526-1937
Mailing Address - Fax:616-301-2501
Practice Address - Street 1:6250 JUPITER AVE NE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-8711
Practice Address - Country:US
Practice Address - Phone:616-301-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704227055363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health