Individual
MR. KYLE GATES HIESTAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
900 PEELER ST, KALAMAZOO, MI 49008-2300
(269) 345-8618
(269) 345-1508
Mailing address
900 PEELER ST, KALAMAZOO, MI 49008-2300
(269) 345-8618
(269) 345-1508
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704291695
MI
163W00000X
Registered Nurse
772359
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
4704291695
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/19/2012
Last updated
09/11/2014
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