Individual
IVANA NYIRENDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1717 SHAFFER ST STE 108, KALAMAZOO, MI 49048-1629
(269) 226-5967
Mailing address
1717 SHAFFER ST STE 108, KALAMAZOO, MI 49048-1629
(269) 226-5967
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5601009532APP19
MI
363A00000X
Physician Assistant
Primary
5601009532
MI
Other
Enumeration date
09/15/2019
Last updated
09/06/2022
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