Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704307448 | MI |
NPI | 1043803760 |
---|---|
Provider Name | Laura Katherine Bevins |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Hastings, MI 49058-1710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2021 |
Last Update Date | 23/08/2021 |