Individual
KYLE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
605 OAK ST, BIG RAPIDS, MI 49307-2048
(616) 364-4200
(616) 364-7347
Mailing address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9493
(616) 364-4200
(616) 364-7347
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704282621
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704282621
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704282621
MI CRNA LICENSE
MI
Enumeration date
04/11/2016
Last updated
04/22/2024
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