Individual ProviderJulie VandeusenPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address200 Jefferson Street, Grand Rapids, MI 49503(616) 685-6781PECOS EnrollmentBased on the most recent information from CMS, provider Julie Vandeusen is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1811404932Provider TypeIndividualFull NameVandeusen, JulieCredentialPAGenderFemaleSole ProprietorNoEnumeration Date1/10/2018Last Updated4/13/2021Contact InformationPractice LocationPractice Address200 Jefferson Street, Grand Rapids, MI 49503Phone(616) 685-6781FaxUnlisted FaxMailing LocationMailing AddressPO Box Q, Grand Rapids, MI 49501-4917PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense5601008529MichiganProvider IdentifiersIDDescriptionIssuerID1811404932DescriptionMedicaidIssuerUnlistedMichigan