Mary Beth Adyniec, NP
Individual provider Active NPI Family Nurse Practitioner · Grand Rapids, MI
NPI 1720006562 · NPPES record last updated Jun 7, 2013
Key facts
- NPI
- 1720006562
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 4704131247 (MI)
- Practice address
- 1246 Madison Ave SE
Grand Rapids, MI 49507-1761 - Phone
- (616) 685-8300
- NPI assigned
- Jul 18, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Mary'S Health Services | Past | Accepting new patients | |
| Trinity Health - Michigan | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704131247 | MI | Yes |
Addresses
Primary practice location
1246 Madison Ave SE
Grand Rapids, MI 49507-1761
Mailing address
245 State St SE
Grand Rapids, MI 49503-4328
Phone (616) 685-1808
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4878622 | Medicaid | MI | |
| 4870508 | Medicaid | MI |
Other providers in Grand Rapids, MI
- Advantage Health/Saint Mary'S Medical Group
- Advantage Health/Saint Mary'S Medical Group
- Advent Rehabilitation, LLC
- Advent Rehabilitation, LLC
- Advisacare Healthcare Solutions, Inc.
- Katherine Aeschlimann
- Bessie E Afendoulis
- Roxanne Beatrice Affholter
- Affinity Dental Care PLC
- Affinity Health Partners Inc
All providers in Grand Rapids, MI · Family Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.