Jayne Deur Pettinga, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704119236 Issued in MI

Practice address

3200 Knight Way SE
Calvin College Health Services
Grand Rapids, MI 49546-4407

Phone

(616) 526-6187

Fax

(616) 526-6548

NPI assigned

Jun 30, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214784000000",
    "number": "1124280219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 KNIGHT WAY SE",
            "address_2": "CALVIN COLLEGE HEALTH SERVICES",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495464407",
            "telephone_number": "616-526-6187",
            "fax_number": "616-526-6548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 KNIGHT WAY SE",
            "address_2": "CALVIN COLLEGE HEALTH SERVICES",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495464407",
            "telephone_number": "616-526-6187",
            "fax_number": "616-526-6548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTINGA",
        "first_name": "JAYNE",
        "middle_name": "DEUR",
        "name_prefix": "Ms.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704119236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breanna Marie Petrucciani, MS, RDN
• Lauren Petruska
• Susanne Pettigrew, PA-C
• Erin Megan Pettijohn, M.D.
• Stuart Pettijohn, DDS
• Matthew Scott Pettinga, MA, LPC
• Taylor Pettit-Rademaker, LMSW, CAADC
• Kayla Lynne Pettit
• Lindsey Pettit, PA-C
• Matia Petty

• Family Nurse Practitioner in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.