Individual
KOREN GEBBEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1959 EAST PARIS AVE SE, GRAND RAPIDS, MI 49546-6272
(616) 808-2695
(616) 808-2697
Mailing address
1959 EAST PARIS AVE SE, GRAND RAPIDS, MI 49546-6272
(616) 808-2695
(616) 808-2697
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
4704277013
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704277013
LICENSE NUMBER
MI
Enumeration date
12/07/2018
Last updated
12/07/2018
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