Mary Carol Vander Wal, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704118232 Issued in MI

Practice address

13712 32ND Ave
Marne, MI 49435-9727

Phone

(616) 677-3633

Fax

(616) 677-5330

NPI assigned

Jun 8, 2009

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

Practice roles

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.

• Cascade Medical Testing Lab, Inc.

  • Clinical Medical Laboratory
  • Grand Rapids, MI
  • NPI 1760557375
  NPD (past)
• Robert Dejonge DO PC

  • Family Medicine Physician
  • Rockford, MI
  • NPI 1508077165
  NPD (past)

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

{
    "created_epoch": "1244419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244419200000",
    "number": "1508092354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13712 32ND AVE",
            "city": "MARNE",
            "state": "MI",
            "postal_code": "494359727",
            "telephone_number": "616-677-3633",
            "fax_number": "616-677-5330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13712 32ND AVE",
            "city": "MARNE",
            "state": "MI",
            "postal_code": "494359727",
            "telephone_number": "616-677-3633",
            "fax_number": "616-677-5330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER WAL",
        "first_name": "MARY",
        "middle_name": "CAROL",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-08",
        "last_updated": "2009-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704118232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela D Staal, RN
• Tessa V Sterling, LCSW
• Wade Randolph Stitt, M.A.C., L.P.C.
• Alexis Renee Sumner, LPC
• Margaret Kimberley Van Hooser, LMSW
• Robin Nicole Zody, PMHNP-BC
• Victoria Zuniga, MSN, RN, PMHNP-BC

• Family Nurse Practitioner in Marne, MI
• Providers in Marne, 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 8, 2009; 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.