Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704281003 | MI |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704281003 | MI |
NPI | 1043797830 |
---|---|
Provider Name | Janiece Ann Feuerstein |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49546-8292 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2018 |
Last Update Date | 17/03/2021 |