Individual
GUSTAVO A MORETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1900 WEALTHY ST SE STE 200, GRAND RAPIDS, MI 49506-2969
(616) 774-0276
(616) 774-5401
Mailing address
100 MICHIGAN ST NE, MC845, GRAND RAPIDS, MI 49503-2560
(616) 486-6790
(616) 486-6702
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704184760
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750566709
—
MI
Enumeration date
01/08/2008
Last updated
06/15/2021
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