Imaobong Ibokette Vanderpool, NP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

4704313471 Issued in MI

Practice address

17256 Roseland Blvd
Southfield, MI 48076-2823

Phone

(248) 388-0881

NPI assigned

Sep 5, 2019

Sex

Female

Sole proprietor

No

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": "1567641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1841849544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17256 ROSELAND BLVD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762823",
            "telephone_number": "248-388-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17256 ROSELAND BLVD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762823",
            "telephone_number": "248-388-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERPOOL",
        "first_name": "IMAOBONG",
        "middle_name": "IBOKETTE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-05",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MI",
            "license": "4704313471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Lynne Vanbeck, RDH
• Dylan Philip Vandell
• Marc Vander Vliet, M.D.
• John G Vanderford, D.O.
• Brittany Vanderhoef
• Vaneni Medical Supplies LLC
• Xiong Vang, CNMT
• Alexis Vanhorn
• Sydney Vanhouten
• Marissa Marie Vankampen

• Primary Care Nurse Practitioner in Southfield, MI
• Providers in Southfield, MI by specialty
• Primary Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2019; 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.