Most Relevant Information
Provider Data
| NPI Number: | 1003263450 |
| Provider Name: | PAUL DIELEMAN PMHNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | 4704247208 |
Most Important Dates
| Enumeration Date: | 05/16/2016 |
| Last Updated: | 11/19/2018 |
Provider Practice Location
1131 IONIA AVE NW
GRAND RAPIDS
MI
495031020
Practice Location Phone/Fax
| Phone: | 6162597900 |
| Fax: | 6162597909 |
Provider Mailing Location
1131 IONIA AVE NW
GRAND RAPIDS
MI
495031020
Provider Mailing Phone/Fax
| Phone: | 6162597900 |
| Fax: | 6162597909 |