Individual
MR. JONATHAN TODD TAKALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9493
(616) 364-4200
(616) 364-7347
Mailing address
3375 BRETON VALLEY DR SE, KENTWOOD, MI 49512-9064
(906) 250-9060
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704255510
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704255510
MI
Other
Enumeration date
12/14/2010
Last updated
12/20/2017
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