Provider Demographics
NPI:1780245027
Name:VANDEZANDE, DOROTHY (CPM, LM)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:VANDEZANDE
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 N 128TH AVE
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-8246
Mailing Address - Country:US
Mailing Address - Phone:231-742-2126
Mailing Address - Fax:
Practice Address - Street 1:3023 N 128TH AVE
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-8246
Practice Address - Country:US
Practice Address - Phone:231-742-2126
Practice Address - Fax:231-346-6050
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7601000003176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty