Chad Underly, L.P.N.

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703103389 Issued in MI

Practice address

1450 Leonard St NE
Grand Rapids, MI 49505-5515

Phone

(616) 446-5101

NPI assigned

Mar 13, 2014

Sex

Male

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1394668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394668800000",
    "number": "1962828087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2809 PORTER ST SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181144",
            "telephone_number": "616-446-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 LEONARD ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055515",
            "telephone_number": "616-446-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDERLY",
        "first_name": "CHAD",
        "credential": "L.P.N.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-13",
        "last_updated": "2014-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703103389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• United Church Homes Inc

• Licensed Practical Nurse in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2014; 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.