Active NPI
Kristin Vanderwell, RN
- Pediatric Nurse Practitioner
- Rockford, MI
National Provider Identifier
1316304744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 4704292621
- Practice address
- 6050 Northland Dr NE Ste 200
Rockford, MI 49341 - Phone
- (616) 685-8350
- Fax
- (616) 363-8870
- NPI assigned
- Jan 15, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 4704292621 | MI | Primary |
Addresses
Primary practice location
6050 Northland Dr NE Ste 200
Rockford, MI 49341
Mailing address
1900 44TH St SE
Kentwood, MI 49508-5008
Other practice location 1
1131 Ionia Ave NW
Grand Rapids, MI 49503-1020
Phone (616) 259-7900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner, Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Interact of Michigan, Inc | Past | Accepting new patients | |
| Advantage Health Saint Mary's Medical Group | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Trinity Health Medical Group
- Multi-Specialty Clinic/Center
- Grand Rapids, MI
- NPI 1952340911
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Kalamazoo, MI
- NPI 1760419691
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537401600000",
"number": "1316304744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 44TH ST SE",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495085008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6050 NORTHLAND DR NE STE 200",
"city": "ROCKFORD",
"state": "MI",
"postal_code": "49341",
"telephone_number": "616-685-8350",
"fax_number": "616-363-8870"
}
],
"practiceLocations": [
{
"address_1": "1131 Ionia Ave NW",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495031020",
"country_code": "US",
"telephone_number": "616-259-7900",
"fax_number": "616-259-7909",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VANDERWELL",
"first_name": "KRISTIN",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-15",
"last_updated": "2018-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MI",
"license": "4704292621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.