Individual
HENRY JUNIOR PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, AGNP-C
Contact information
Practice address
2060 DIVISION AVE S, GRAND RAPIDS, MI 49507-3029
(616) 475-8446
Mailing address
3330 HILLCROFT AVE SW, GRAND RAPIDS, MI 49548-2148
(616) 856-1992
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704238185
MI
363LA2200X
Adult Health Nurse Practitioner
Primary
AG07240076
MI
363LG0600X
Gerontology Nurse Practitioner
AG07240076
MI
Other
Enumeration date
10/09/2024
Last updated
10/18/2024
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