Individual
KIMBERLY ANN GONYEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3600 E FULTON, GRAND RAPIDS, MI 49546-1322
(616) 949-4971
(616) 248-3530
Mailing address
36115 SCHOOLCRAFT RD, LIVONIA, MI 48150-1216
(734) 793-6140
(734) 402-0254
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704153798
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KG153798
BLUE SHIELD
MI
Enumeration date
08/29/2006
Last updated
11/11/2014
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