Individual
MS. KRISTEN NICOLE GILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4294 LAUREL DR, LAKE ODESSA, MI 48849-8430
(616) 374-7660
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
(616) 486-6790
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010969
MI
Other
Enumeration date
04/07/2022
Last updated
10/10/2022
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