Individual
MR. JOHN NICHOLAS GOULD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17288 180TH AVE, LEROY, MI 49655-8420
(231) 388-0018
Mailing address
17288 180TH AVE, LEROY, MI 49655-8420
(231) 388-0018
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
AF670277211
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123456789
SHADY PINES AFC HOME
MI
Enumeration date
12/14/2011
Last updated
12/14/2011
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