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Individual

CHESTER G PROFETA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
BSN, MSN

Contact information

Practice address
1260 AJIJAAK AVE, PETOSKEY, MI 49770-8330
(714) 588-6659
(231) 242-1700
Mailing address
2571 SKYLARK DR, SAN JOSE, CA 95125-2942
(714) 588-6599

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
846065
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704420286
MI

Other

Enumeration date
05/29/2023
Last updated
11/26/2024
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