Bradley Allen Vanderhulst, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703111898 Issued in MI

Practice address

1713 7TH St
Muskegon, MI 49441-2426

Phone

(231) 726-1214

NPI assigned

Jan 22, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Catholic Charities West Michigan

  • Substance Abuse Rehabilitation Facility
  • Muskegon, MI
  • NPI 1699378216
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1043800170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 WOLF RIVER CT NW",
            "city": "WALKER",
            "state": "MI",
            "postal_code": "495343460",
            "telephone_number": "616-644-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1713 7TH ST",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494412426",
            "telephone_number": "231-726-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERHULST",
        "first_name": "BRADLEY",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-22",
        "last_updated": "2021-11-04",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703111898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LARA",
            "identifier": "4703111898",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hanna Vanden Berg, PA-C
• Joshua Stewart Vandenberg, BBA
• Eleysia Jade Vandenbosch
• Nicholas Alan Vandenbosch, D.O.
• Rebecca A Vandenbroek, PA
• Darlene June Vanderkolk, LMSW
• Theodore J. Vanderkooi, M.D.
• Vickie L Vanderlaan
• Robert Vandermeer, OTR
• Julie Ann Vandermeulen, MSW

• Licensed Practical Nurse in Muskegon, MI
• Providers in Muskegon, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.