Individual
ROBERT GASTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
665 POWERS AVE NW, GRAND RAPIDS, MI 49504-5058
(616) 304-5310
Mailing address
665 POWERS AVE NW, GRAND RAPIDS, MI 49504-5058
(616) 304-5310
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703094665
MI
Other
Enumeration date
05/28/2015
Last updated
05/28/2015
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